Course and prognosis of bipolar disorder

The development of bipolar disorder occurs most often in young people. At the age of 15 to 19 years account for the majority of cases, the first signs of the disease.        

The relationship between the first signs of bipolar disorder and age is shown in the figure. 

Bipolar disorder (manic-depressive psychosis) is a complex disease in which various symptoms and disorders are noted : mania and depression of varying severity, mixed conditions. Disorders of appetite, sleep, etc. often occur . The severity of these symptoms at different periods of the disease varies.      

The development of the phases of bipolar disorder is autochthonous. With the onset of intermission, an euthyme mood takes place when the patient is critical of the painful episode he has suffered. After the affective cycle, there is an euthymic period. During this period, the course of the disease is called alternating. Intermission lasts 4.5 years and occurs after the first phase. During the subsequent phases, the duration of the light intervals decreases, then it stabilizes and is 1 year. The aggravation of the disease occurs gradually; more severe depressions are replaced by light ones, manic states develop. In some patients, the disorder begins to acquire a bipolar character, the light gaps between the phases are reduced and disappeared. There is a continual course of the disease.         

The continual course of the disease is the most favorable. With a similar course, 4 phases develop : a major depressive episode, mania, hypomania, and a mixed episode over the past year. These phases are separated by remission, the phases can end in the inversion of affect, and the opposite phase also develops.    

After the start of the use of antidepressants and electroconvulsive therapy, there was an increase in bipolar exacerbations, 16% of patients suffered more than 20 episodes.    

People with bipolar disorder lose about 9 years of productive life. Examination revealed various psychopathological symptoms in the interictal period in 70% of patients , and comorbid disorders in 65% .      

Suicide in bipolar disorder

It was found that with bipolar disorder, one suicidal attempt was made by 8% of patients, and ΒΌ of all attempts were made in the first 2 years after the onset of the disease.    

The increased risk of suicide in bipolar disorder is possible due to the following factors:

  • illness at an early age; 
  • depression;
  • severe depression in the last phase; 
  • alcoholism;
  • abrupt withdrawal of therapy;
  • ineffective normotimal therapy.

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