Patients included in this study were a convenience sample of all inpatients with bipolar disorder admitted to Jining Psychiatric Hospital from January 1st, 2016 to December 31th 2016. There were 372 males [Duration of illness (9.75 ± 10.60) years] and 370 females [Duration of illness (9.61 ± 10.04) years] aged 18–60 years old, with a current diagnosis of bipolar disorder recruited for this study. Selection criteria included: a primary diagnosis of bipolar disorder according to the International Classification of Diseases-10 (ICD-10), a score of 5 or lower on the Bech-Rafaelsen mania rating scale (BRMS) (14), a score of 8 or lower on the Hamilton depression scale (HAMD) (15), the ability to understand and sign the consent form, and no substance use disorder in the last 3 months. Subjects were divided into two subgroups according to their onset symptoms. The mania group included 318 patients; the other 424 patients belonged to the depression group. This study was carried out in accordance with the principles of informed consent and the Institutional Review Board for Jining Psychiatric Hospital approved the study and its informed consent procedures. Subjects provided written, informed consent after receiving a complete description of the study and after being given chances to ask questions about their participation.

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