[The course of bipolar disorder before the manifestation of the first manic stage]

The study aimed to establish prognostic considerations for the course of bipolar affective disorder from its onset till first manic phase in persons in whom depression was that first clinical phase of the disorder. Studied group comprised of 80 patients (34 males and 46 females) with the disorder lasting for 11 to 50 years. Within the evaluated period as positive prognostic factors were identified an early onset of the disorder (before 30 years of age), a short (lasting less than 3 months) first depressed phase and a long (above 5 years) first remission. In women and in persons who had lost their parents before 14 years of age the course of disorder was more severe as indicated by duration and frequency of depressed phases. The time of duration of the disorder until the first manic phase was not influenced by pharmacotherapy. Both, treated and untreated depressions more frequently ended with remission (77% of episodes) than switch to mania (23% of episodes). Perris' criterion for diagnosis of unipolar affective disorder has rather limited value since in almost half of the studied individuals a risk of occurrence of a manic phase following three successive depressed phases still existed and diagnosis was still an open question.