A lifelong condition with periods of partial or full recovery in between recurrent episodes of relapse,<unk>  is considered to be a major health problem worldwide because of the increased rates of disability and premature mortality. It is also associated with co-occurring psychiatric and medical problems, higher rates of death from natural causes (e.g., cardiovascular disease), and high rates of initial under- or misdiagnosis, causing a delay in appropriate treatment and contributing to poorer prognoses. When compared to the general population, people with<unk>  also have higher rates of other serious medical comorbidities including diabetes mellitus, respiratory diseases, HIV, and Hepatitis C virus infection. After a diagnosis is made, it remains difficult to achieve complete remission of all symptoms with the currently available psychiatric medications and symptoms often become progressively more severe over time. Compliance with medications is one of the most significant factors that can decrease the rate and severity of relapse and have a positive impact on overall prognosis. However, the types of medications used in treating<unk>  commonly cause side effects and more than 75% of individuals with<unk>  inconsistently take their medications for various reasons. Of the various types of the disorder, rapid cycling (four or more episodes in one year) is associated with the worst prognosis due to higher rates of self-harm and suicide. Individuals diagnosed with bipolar who have a family history of<unk>  are at a greater risk for more frequent manic/hypomanic episodes. Early onset and psychotic features are also associated with worse outcomes, as well as subtypes that are nonresponsive to lithium. Early recognition and intervention also improve prognosis as the symptoms in earlier stages are less severe and more responsive to treatment. Onset after adolescence is connected to better prognoses for both genders, and being male is a protective factor against higher levels of depression. For women, better social functioning before developing<unk>  and being a parent are protective towards suicide attempts. Functioning Changes in cognitive processes and abilities are seen in mood disorders, with those of<unk>  being greater than those in major depressive disorder. These include reduced attentional and executive capabilities and impaired memory. People with<unk>  often experience a decline in cognitive functioning during (or possibly before) their first episode, after which a certain degree of cognitive dysfunction typically becomes permanent, with more severe impairment during acute phases and moderate impairment during periods of remission. As a result, two-thirds of people with<unk>  continue to experience impaired psychosocial functioning in between episodes even when their mood symptoms are in full remission. A similar pattern is seen in both<unk> -I and<unk> -II, but people with<unk> -II experience a lesser degree of impairment. When<unk>  occurs in children, it severely and adversely affects their psychosocial development. Children and adolescents with<unk>  have higher rates of significant difficulties with substance abuse, psychosis, academic difficulties, behavioral problems, social difficulties, and legal problems. Cognitive deficits typically increase over the course of the illness. Higher degrees of impairment correlate with the number of previous manic episodes and hospitalizations, and with the presence of psychotic symptoms. Early intervention can slow the progression of cognitive impairment, while treatment at later stages can help reduce distress and negative consequences related to cognitive dysfunction. Despite the overly ambitious goals that are frequently part of manic episodes, symptoms of mania undermine the ability to achieve these goals and often interfere with an individual's social and occupational functioning. One-third of people with<unk>  remain unemployed for one year following a hospitalization for mania. Depressive symptoms during and between episodes, which occur much more frequently for most people than hypomanic or manic symptoms over the course of illness, are associated with lower functional recovery in between episodes, including unemployment or underemployment for both<unk> -I and<unk> -II. However, the course of illness (duration, age of onset, number of hospitalizations, and the presence or not of rapid cycling) and cognitive performance are the best predictors of employment outcomes in individuals with<unk> , followed by symptoms of depression and years of education. Recovery and recurrence A naturalistic study in 2003 by Tohen and coworkers from the first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years. Within two years, 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). However, 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19% switched phases without recovery. Symptoms preceding a relapse (prodromal), especially those related to mania, can be reliably identified by people with<unk> . There have been intents to teach patients coping strategies when noticing such symptoms with encouraging results. Suicide<unk>  can cause suicidal ideation that leads to suicide attempts. Individuals whose<unk>  begins with a depressive or mixed affective episode seem to have a poorer prognosis and an increased risk of suicide. One out of two people with<unk>  attempt suicide at least once during their lifetime and many attempts are successfully completed. The annual average suicide rate is 0.4%, which is 10–20 times that of the general population. The number of deaths from suicide in<unk>  is between 18 and 25 times higher than would be expected in similarly aged people without<unk> . The lifetime risk of suicide has been estimated to be as high as 20% in those with<unk> . Risk factors for suicide attempts and death from suicide in people with<unk>  include older age, prior suicide attempts, a depressive or mixed index episode (first episode), a manic index episode with psychotic symptoms, hopelessness or psychomotor agitation present during the episodes, co-existing anxiety disorder, a first degree relative with a mood disorder or suicide, interpersonal conflicts, occupational problems, bereavement or social isolation.
Bipolar disorder
Substance use disorder
Major depressive disorder
Attention deficit hyperactivity disorder
Bipolar I disorder
Schizophrenia
Major depressive episode
Personality disorder