Remission from BD tends to occur in the majority of treated patients, but, over time, relapse occurs in more than half of those who remit. Past history and functional status are the most potent predictors of course, and polarity has differential prognostic significance on outcomes. Comorbid disorders are broadly associated with both relapse and lower rates of functional recovery, but the specific mechanisms and methods for incorporating these conditions in studies of course require further consideration. One of the most disconcerting results from the aggregate research on the course of BD is that there has been little change in the frequency of episodes with mood stabilizer treatment, even though these medications reduce syndromic and symptomatic severity. There is general agreement that prediction could be improved by diagnosis of the condition earlier in the course of the illness and consideration of functional status as well as clinical symptoms as important targets of treatment.27 Likewise, application of a dimensional assessment of the core components of BD may reduce the complexity in distinguishing between syndromal and symptomatic outcomes at follow-up. A broader conceptualization of remission in BD that incorporates quality of life and cross-domain functional level may provide a more accurate depiction of course and outcome.
Finally, this negative picture may not represent the full spectrum of BD in the population because of the focus on patients drawn from sources characterized by the most severe end of the BD spectrum. In fact, integration of preliminary findings from community samples with the important body of work reviewed herein may actually shift the negative valence of the prognosis of BD in a more positive direction based on the high frequency of remission of BD in community samples.