The puzzle of noncompliance in the manic patient.

Patients with affective disorders may be seriously compromised by failure to comply with prescribed medication regimens. At the time of his hospitalization, the patient discussed here had a severe bipolar disorder characterized by disruptive and repetitive manic episodes that were generated by medication noncompliance and substance abuse. Through an understanding of the longitudinal and progressive development of this rapidly cycling disorder, the consultant emphasizes the importance of long-term maintenance pharmacotherapy in the context of environmental restructuring to attempt to reverse the malignant nature of the patient's affective disorder.