Sociodemographic characteristics, psychoactive substance use, and an operational marker of recurrent and complex behavioral patterns in patients hospitalized for bipolar disorder: a cross-sectional study

Abstract Introduction Bipolar disorder is a chronic psychiatric condition characterized by high heterogeneity and variable clinical severity, the manifestation of which may be influenced by certain sociodemographic factors and psychoactive substance use. This study aims to evaluate the association between these factors and an operational marker of the clinical course of bipolar disorder in a population receiving psychiatric care. Population and methods This is a cross-sectional study conducted between March 2024 and December 2025 among 98 patients with bipolar disorder type 1 or 2, according to DSM-5 criteria, who were hospitalized at the Arrazi University Psychiatric Hospital in Salé, Morocco. Sociodemographic, clinical, and substance use data were collected from medical records and semi-structured questionnaires administered directly to the patients. The substances assessed included tobacco, cannabis, alcohol, and cocaine, taking into account current use at the time of assessment. Polysubstance use was defined as the simultaneous use of at least two substances. The complex operational marker was defined by the presence of at least 3 lifetime hospitalizations and at least two of the following manifestations: hyperactivity, aggression, or irritability. Univariate and multivariate statistical analyses were conducted to identify factors associated with a more complex clinical course of bipolar disorder. The marker was present in 30 participants (30.6%). All participants signed informed consent forms, and the study was approved by the Research Ethics Committee of the Faculty of Medicine and Pharmacy in Rabat, Morocco. Results The results of this study highlight the prevalence of substance use, which was 55.1% for tobacco, 34.7% for cannabis, and 37.8% for alcohol. In bivariate analysis, tobacco use was significantly associated with the operational marker of clinical course of bipolar disorder ( p = 0.016; crude OR: 3.09; 95% CI [1.21–7.92]). After multivariate adjustment, current cannabis use was associated with the presence of the marker (ORa = 2.981; 95% CI 1.063–8.358; p = 0.038). Additionally, an association was observed between disease duration and the presence of the marker (ORa = 1.054; 95% CI 1.002–1.109; p = 0.040). Conclusion This study explored associations between certain factors and an operational marker of a recurrent and complex clinical course of bipolar disorder. Current cannabis use and a longer duration of illness were associated with the presence of the operational marker. These results should be interpreted with caution given the cross-sectional and exploratory nature of the study.