Considerazioni sul decorso dei disturbi bipolari

The onset of bipolar is around 20 years of age. This seems to be an important diagnostic cue, because early symptoms of bipolar disorder are often depressive, thus an incorrect diagnosis of major depressive disorder could be established; the fact that unipolar depression more often appears later in life could therefore suggest an hypothesis of bipolar depression. An early onset is associated to a greater severity as well as to positive family history of bipolar disorder. The onset is often preceded by stressful life events. The relation between onset of bipolar disorder and stressful life events seems supported only in early episodes, whereas the later ones seem to occur independently consistent with the kindling hypothesis. As affective episodes occur, the interval within episodes shortens, thus leading to increased frequency of episodes over time. This could sometimes lead to the disappearance of intervals between episodes and produce a continued- or rapid-cycling pattern, less responsive to mood stabilizers such as lithium and also frequently induced by the use of tricyclics. Long-term follow-up studies have shown that the probability of recurrence increases over years following the index episode, from 40% after one year to 80% after five years. The same studies have shown the presence of residual functional impairment even between episodes in more than half of the patients included, pointing for a revision of Kraepelin's statement that manic-depressive illness should bring to fully recovery after each effective episode. At the same time these results indicate the need for enhancing pharmacological treatment with other techniques such as some types of psychotherapy.