Individuals with bipolar disorder (BD) have a higher prevalence of tobacco smoking than the general population. In Egypt, the accurate data about the pattern of tobacco smoking and prevalence of nicotine dependence among BD patients are still scarce.

The objective of this study was to detect the pattern of tobacco smoking and to assess the occurrence of nicotine dependence syndrome among Egyptian cigarette and waterpipe smoker patients suffering from BD.

A cross-sectional study using a semistructured interview to assess 100 patients with BD at the inpatient department and the outpatient mood clinic of The Institute of Psychiatry, Ain Shams University. The assessment tools included the Mini-International Neuropsychiatric Interview, Sixth Edition (M.I.N.I.), the Young Mania Rating Scale (YMRS), the Fagerström Test for Nicotine Dependence (FTND), and the Lebanon Waterpipe Dependence Scale (LWDS-11).

Of the 100 recruited bipolar patients (43% women and 57% men), it was found that 45% of bipolar cases were cigarette smokers, 18% were waterpipe smokers, and 17% smoked both cigarette and waterpipe with a statistically significant difference. Bipolar I in the acute phase showed the most prevalent type of BDs with moderate (31%) and high (13.8%) nicotine dependence. Bipolar II cases have never smoked neither cigarette nor waterpipe; 5% of patients with bipolar I smoked waterpipe during disease activity.

Patients with BD have a relatively high frequency of nicotine (cigarettes and waterpipe) dependence (17%) in relation to the general population (1.0%), especially bipolar I type.