This study aims to determine the long-term safety of a medication called **KarXT** for treating manic episodes in people with **Bipolar-I Disorder**. Manic episodes are periods of extremely high energy, mood swings, and erratic behavior. **KarXT** is a drug being tested to see how well patients tolerate it over time. To join the study, participants must have either taken part in a previous related study or be newly diagnosed with Bipolar-I Disorder. The disorder must be confirmed through evaluations, and participants should have specific scores on the **Young Mania Rating Scale (YMRS)** and **Clinical Global Impressions for Bipolar Disorder (CGI-BP)**. Certain conditions, like a high risk of suicidal behavior or other severe mental disorders, may disqualify participation. Key Points:

• The study is open-label, meaning both doctors and participants know they are receiving KarXT.
• Participants must not have severe constipation or other risk factors like urinary retention.
• Participants cannot be at high risk of suicide or have certain other psychiatric disorders.