The Longitudinal Course of Bipolar Disorder

Course of illness is central to our focus on bipolar disorder due to the lifelong nature of this illnessin the majority of patients. In this overview, we highlight areas of consensus and debate on factors thatimpact course of illness. Findings on age at onset, psychiatric comorbidity, frequency of episodes,cycle pattern, rapid cycling, mixed symptoms, and precipitants of episodes including use of substancesand antidepressants and lithium discontinuation are discussed. The diversity and range of presentationand even course of illness become quickly apparent in this review. Highlighting these factorsrather than seeking a unifying theory should be a productive way to refine our ability to identifyadditive factors contributing to course of illness for patients with bipolar disorder.