Citation

Gitlin M, Rapaport MH. Prim. Psychiatry 2003; 10(6): 1-10.

Copyright

(Copyright © 2003, MBL Communications)

DOI

unavailable

PMID

unavailable

Abstract

Bipolar disorder is both a chronic and recurrent illness in which patients are symptomatically ill 50% of the time and mostly in a depressed rather than manic state. Among bipolar disorder patients, >80% relapse within 5 years of recovery and two thirds of those with bipolar I will suffer a subsequent episode of mania over the next 10 years. Duration of episodes are approximately 3 months for major depressive, 1.5 months for manic, and >4 months for rapid cycling or mixed episodes. Depressive episodes may initiate rapid cycling, which occurs in 10% to 15% of patients. Consequences of bipolar disorder include decreased level of functioning in all domains, including impairment in family and social relationships, lower socioeconomic status, increased rates of alcohol and substance abuse, increased mortality from suicide and natural causes, and overall higher cost to society. Prognosis and recurrence of the disorder may be predicted based on type of episode as follows: 70% of patients with psychotic mania relapse compared to only 20% of patients with nonpsychotic mania, and 90% of patients with mood incongruent delusions relapse compared to 60% of those with mood congruent delusions. In addition, conversion from bipolar II to bipolar I is highly unlikely. The definition of remission, defined as complete resolution of all symptoms of the disorder, is complicated by the complex relationship that exists between relapse and function: While patients may show initial syndromal recovery, functional recovery usually takes much longer to occur. The circular relationship between symptomatic episodes and functional recovery requires both combined pharmacotherapy, to reduce symptoms, as well as psychotherapy, to better cope with stress, in order to achieve true remission.

Language: en