Causes for recidivism in bipolar manic-depressive disorder

A prospektive multidimensional study with 71 remitted bipolar outpatients (37 bipolars without, 34 with psychotic symptoms during acute mania) was made to assess relevant influential factors on relapse and readmission to hospital: characteristic data of previous course, psycho(patho)logical state and personality after remission, personality disorders, and ways of coping. In the course of the 5 years after the first examination, 48% of the patients were readmitted, 60% of them because of a (schizo)manic state. The study confirms the prognostic relevance of past course, e.g. number of previous episodes and mania-quotient. A further risk-factor are residual psychopathological alterations which persist after remission ("negative symptoms" of strictly bipolars, increased vulnerability for dynamic derailment for the bipolars with psychotic symptoms). Patients with "syntonic" personality in the free interval suffered less relapses. The relevance of other personality traits differed in the diagnostic subgroups of nonpsychotic and psychotic bipolars. Active coping was positively correlated with staying healthy, but the correlations were weak.