Criminal liability and Bipolar Disorder in Spain: A systematic analysis of 182 judicial sentences (2019–2024)

Bipolar Disorder (BD) is a chronic and cyclical mood disorder characterized by fluctuations between an expansive or diminished mood. In the Spanish legal framework, BD is a recognized clinical condition that may significantly modify criminal liability, potentially leading to findings of non-imputability. Methodology A retrospective and systematic review of criminal court sentences in Spain was conducted over a 5-year period (2019–2024), focusing on cases involving manic symptomatology. A total of 182 sentences were identified and analyzed to characterize the sociodemographic, clinical, and judicial variables of the defendants. Results The sample was predominantly male (81.87%), with a high prevalence of social isolation (76.92% lacked family support). While 69.23% had a prior BD diagnosis, a significant majority were not receiving pharmacological treatment (61.54%) or psychiatric follow-up (64.29%) at the time of the offense. Most defendants had a prior criminal record (63.74%). Regarding judicial outcomes, the most frequent results were appeal dismissals (37.36%) and prison sentences (28.57%). Notably, court-ordered pharmacological treatment was applied in 6.59% of cases, while BD was considered a full exonerating factor in only 3.3% of the sample. Conclusions The findings highlight a strong correlation between social vulnerability, treatment non-adherence, and criminal involvement in BD patients. There is an urgent need for standardized forensic protocols and interdisciplinary training to ensure that judicial measures are clinically appropriate and proportionate to the defendant's mental state.