Long-term remission and recovery in bipolar disorder: a review.
Longitudinal outcome studies of bipolar disorder show that most patients encounter affective recurrences, interepisode symptoms, and residual functional impairment. The kindling model suggests that the timing and periodicity of recurrent episodes may help to predict future illness course. This article examines contemporary data regarding patterns of affective recurrence, and the extent to which variable versus consistent or sustained remissions influence long-term illness course. Consequences of affective recurrence are examined from psychosocial, pharmacologic, and neurobiological perspectives. Multiple affective recurrences may be linked with subsequent treatment resistance, psychosocial disability, and possible functional neuroanatomic changes. Existing data support the prognostic importance of effective treatment early in the course of illness, with a goal to achieve and maintain clinical homeostasis.
Goldberg
Joseph F
JF
Silver Hill Hospital, 208 Valley Road, New Canaan, CT 06840, USA. JFGoldberg@yahoo.com
Garno
Jessica L
JL
Harrow
Martin
M
D000339:Affect; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy*; D018450:Disease Progression; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004358:Drug Therapy; D006801:Humans; D008137:Longitudinal Studies; D008960:Models, Psychological; D011379:Prognosis; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents