Bipolar disorder longitudinal

Goodwin FK, Roy-Byrne P Treatment of bipolar disorders, in Psychiatry Update The American Psychiatric Association Annual Review, Vol 6. Edited by fJales RE, Francis AJ. Washington, DC, American Psychiatric Press, 1987, p 89 Goodwin FK, Murphy DL, Bunney WE lithium-carbonate treatment in depression and mania a longitudinal double-blind study. Arch Gen Psychiatry 21 486-496, 1969... 

The patient s age—the younger the patient, the greater the chance that the course will be that of a bipolar disorder on longitudinal follow-up... 

Some patients initially diagnosed as having borderline disorder and followed longitudinally will develop periodic exacerbations in their interpersonal relationships. At times, they may even be reclassified as having either a classic bipolar disorder, a subsyndromal variant, or an atypical presentation. Peselow et al. ( 38) studied 66... 

Maintenance and prophylaxis with lithium, and perhaps other mood stabilizers, favorably alters the longitudinal course of a bipolar disorder. Thus, efforts to enhance long-term compliance are a necessary part of any overall strategy. The incidence of adverse or toxic events is relatively low, and close attention to the more clinically relevant consequences can usually prevent serious sequelae ( 198).An issue of critical importance for future research is the potential efficacy of alternative maintenance medication for those who fail to respond adequately to acute or long-term lithium therapy. 

The longitudinal course of bipolar illness is also characterized by many recurrent episodes, some predominantly depressive, some predominantly manic or hypomanic, some mixed with simultaneous features of both mania and depression (Fig. 5—5) some may even be rapid cycling, with at least four ups and/or downs in 12 months (Fig. 5—6). There is worrisome evidence that bipolar disorders may be somewhat progressive, especially if uncontrolled. That is, mood fluctuations become more frequent, more severe, and less responsive to medications as time goes on, especially in cases where there has been little or inadequate treatment. 

Goldberg JF, Harrow M, Grossman LS. Course and outcome in bipolar affective disorder a longitudinal follow-up study. Am J Psychiatry 1995 152 379-384. 

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