The Bipolar Disorder has a more variable course over time than most other mental disorders. Dr. Rodriguez conducted a mental status exam as described in the cases of Ricky and Barbara. As with Barbara, the psychiatrist was particularly interested in Sally's risk of suicide and other violent tendencies, and her current and lifetime history of substance use. Dr. Rodriguez decided that Sally's behavior indicated both mania and depression, and it was important that she had described the past several days of this kind of pattern as typical for her. Given Sally's instability, the possibility she would do something self-destructive was a serious concern. Suicide risk is lower during the manic phase of Bipolar Disorder than the depressive phase, but is still above average. Dr. Rodriguez understood that use of substances can reflect efforts at self-medication and can mislead the clinician by masking the underlying Bipolar Disorder.