In more than 90% of patients, further episodes occur after the first episode - in one in two people within 2 years of the disease. Only 7-10% do not relapse. The average number of relapses is difficult to assess - the most common figure is 6 to 10. In some patients, relapses occur regularly, sometimes with a seasonal pattern. Approximately 40 per cent of patients have long periods of health between episodes (lasting from several days to several years), one in ten has a chronic course and one in five has one episode immediately after another (so-called alternating course). As the disease progresses, periods of health shorten and illnesses lengthen.

Almost one in five patients will experience at least four relapses within a year - this is then referred to asrapid cycling BPAD. The majority of patients with this pattern actually experience more than four episodes per year - some studies have even found up to sixteen episodes. This pattern of BPAD is more common in women and is more difficult to treat. It is fortunately transient in many patients.

Treatment

The choice of treatment depends on the patient's clinical condition. Mood-stabilising drugs (lithium carbonate, valproic acid derivatives, carbamazepine, lamotrigine) are required both during the illness (irrespective of the phase type) and in remission to prevent relapse. If necessary, depending on the phase of the illness, other drugs are included - in more severe depressive episodes, antidepressants and, if necessary, an antipsychotic drug, and in more severe manic episodes, antipsychotics.

Electroconvulsive therapy is sometimes necessary in BPAD patients with severe depression.

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Prognosis
BPAD is a serious health and social problem. The prognosis is uncertain, to say the least, and depends on a number of factors, such as the pattern of the disease, the age of onset and the length and quality of health periods. It is also important how the patient responds to medication, especially mood stabilisers.

People who experience relapses less frequently have less difficulty continuing to work. Severe manic episodes severely impair functioning because of the decisions made and conflicts with the environment during them. Early onset can become an obstacle to completing education, gaining professional qualifications and achieving independent living. Depressive relapses are associated with a high risk of suicide - up to one in two (25-50%) BPAD patients make suicide attempts. Periods of distress are sometimes accompanied by abuse of alcohol or other substances (including anti-anxiety medication, sleeping pills), which can lead to addiction. BPAD sufferers are less likely than healthy people to choose to marry, and are more likely to divorce.


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4. Andreasen N.C., Black D.W.: Introductory Textbook of Psychiatry, American Psychiatric Publishing, London 2001
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