[ABSTRACT] Although genetic and biological factors are crucial in the pathophysiology of bipolar disorder, the importance of psychosocial factors in triggering or mitigating relapses warrants the implementation of psychotherapeutic interventions as adjunctive therapy to phamacological treatment. Some studies have associated some family attitudes, as high expressed emotion in relatives, with poorer outcome in bipolar disorder. The role of the environmental stress in the course of bipolar disorder