Prognosis
Recurrence is almost certain, as most people with bipolar disorder have more than one lifetime episode. Although considerable variability exists regarding relapses across individuals with bipolar disorder, the evidence indicates that, over time, episodes become more frequent, and euthymic intervals become shorter between episodes. Some people may have chronic subsyndromal symptoms.
Manic episodes typically have an abrupt onset, developing over a few days, while depressive episodes usually develop more gradually. With treatment, episodes of mania, depression, or mixed states last approximately 3 to 4 months.[275] Relapses occurring shortly after remission typically return to the most recent pole (depressive or manic) of illness. However, during longer-term follow-up, in 85% of cases the next episode is of the opposite polarity.[30] Life events or triggers often precipitate episodes, although this effect is more prominent in earlier than in later phases of bipolar disorder.[30]
The overall long-term outcome for bipolar disorder based on prospective cohort natural history studies is not good. Although treatments are effective at reducing symptoms, and episodes usually remit, only a minority of patients are well over long-term follow-up. Over an average of 13 years of follow-up, the main outcome of treated bipolar I disorder was chronic subsyndromal depression; patients were symptomatic despite treatment 47% of the time, with the majority of symptomatic time spent experiencing depressive rather than manic or mixed symptoms.[29] Patients with bipolar II were symptomatic 54% of the time, again with the depressive burden heavily outweighing the hypomanic burden.[276]
Mortality is higher in patients with bipolar disorder than in the general population. The standardized mortality ratio for bipolar disorder due to cardiovascular disease ranges between 1.2 and 3.0, while the standardized mortality ratio for suicide is between 14.0 and 23.4.[30]
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