Course and outcome of bipolar disorder: Focus on depressive aspects

Abstract

The presence of depressive symptoms dominates the longitudinal course of bipolar disorder (BD) and predicts functional impairment. Despite great progress in understanding the biological basis of BD, the course and outcome of the illness can only be predicted using clinical variables. This chapter summarizes the main factors that predict course and outcome in BD with a focus on depressive symptoms. The natural course of the illness, the impact of the first episode, the impact of the depressive phase, cycle length, onset, age, gender, type of illness, personality traits, temperament, comorbidity, family history, life events, and outcome features will be reviewed. Conceptual models such as disease staging and their prognostic value will also be discussed.