Background: Bipolar disorder is one of the most severe forms of mental disorders,rnand is clinically characterized by profound mood swings. Bipolar disorder is anrnepisodic condition requiring long-term, often life-long, treatment to control acuternsymptoms and stabilize mood. Despite recommendations by some treatmentrnguidelines to avoid use of first generation antipsychotics(FGAs) in maintenancerntreatment of bipolar disorder, their use is highly prevalent especially in resourcernlimited countries like Ethiopia.rnObjective: To assess the impact of the long term use of FGAs in the course andrnoutcome of bipolar I disorder.rnMethods: The Longitudinal Interval Follow-up Evaluation(LIFE) chart was used torncollect detailed psychosocial, psychopathologic and treatment outcome information.rnResults: Among the study participants who were at risk for relapse, 86.5% hadrnexperienced relapse during their follow-up. Duration on daily FGAs dose â‰¥ 300mgrnChlorpromazine(CPZ) equivalents was significantly associated with relapse rate inrnbipolar I disorder. While FGAs use did not predict remission and overall functioningrnimprovement, remission was negatively associated with duration of treatment onrndaily FGAs dose â‰¥ 300mg CPZ equivalents. Furthermore, duration on FGAsrnsignificantly increased the risk for EPS. On the other hand, FGAs use did not predictrnsuicidality in bipolar I patients.rnivrnConclusion: Findings from the current study suggest that benefits of the long termrnuse of FGAs in bipolar disorder are doubtful. Therefore, providing access torneffective medications such as mood stabilizers may be relevant next steps tornoptimize the outcome of bipolar disorder in settings where FGAs are widely used.rnKey words: First generation antipsychotics, bipolar disorder, maintenancerntreatment, prophylaxis, outcome, Ethiopia