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Prognosis
There is evidence to suggest that Bipolar II Disorder has a more chronic course of illness than Bipolar I Disorder. This constant and pervasive course of the illness leads to an increased risk in suicide and more hypomanic and depressive episodes with shorter periods of time between episodes than Bipolar I patients experience. The natural course of Bipolar II Disorder, when left untreated, leads to patients spending the majority of their lives unwell with most of their suffering stemming from depression. Their recurrent depression results in personal suffering and disability. This disability can present itself in the form of psychosocial impairment, which has been suggested to be worse in Bipolar II patients than in Bipolar I patients. Another facet of this illness that is associated with a poorer prognosis is rapid cycling, which denotes the occurrence of four or more Major Depressive, Hypomanic, and/or mixed episodes in a twelve month period. Rapid cycling is actually quite common in those with Bipolar II, much more so in women than in men (70% vs. 40%), and without treatment leads to added sources of disability and an increased risk of suicide. In order to improve a patient’s prognosis, long term therapy is most favorably recommended for controlling symptoms, maintaining remission and preventing relapses. With treatment, patients have been shown to present a decreased risk of suicide (especially when treated with Lithium) and a reduction of frequency and severity of their episodes, which in turns moves them toward a stable life and reduces the time they spend ill. In order to maintain their state of balance, therapy is often continued indefinitely, as around 50% of the patients who discontinue it relapse quickly and experience either full-blown episodes or sub-syndromal symptoms that bring significant functional impairments.

Functioning

The deficits in functioning associated with Bipolar II Disorder stem mostly from the recurrent depression that Bipolar II Patients suffer from. Depressive symptoms are much more disabling than hypomanic symptoms and are potentially as or more disabling than mania symptoms. Functional impairment has been shown to be directly linked with increasing percentages of depressive symptoms, and because sub-syndromal symptoms are more common—and frequent—in Bipolar II disorder, they have been implicated heavily as a major cause of psychosocial disability. There is evidence that shows the mild depressive symptoms, or even sub-syndromal symptoms, are responsible for the non-recovery of social functioning, which furthers the idea that residual depressive symptoms are detrimental for functional recovery in patients being treated for Bipolar II. It has been suggested that symptom interference in relation to social and interpersonal relationships in Bipolar II Disorder is worse than symptom interference in other chronic medical illnesses such as cancer. This social impairment can last for years, even after treatment that has resulted in a resolution of mood symptoms. The factors related to this persistent social impairment are residual depressive symptoms, limited illness insight (a very common occurrence in patients with Bipolar II Disorder), and impaired executive functioning. Impaired executive functioning is directly tied to poor psychosocial functioning, a common side-effect in patients with Bipolar II. The impact on a patient’s psychosocial functioning stems from the depressive symptoms (more common in Bipolar II than Bipolar I). An increase in these symptoms’ severity seems to correlate with a significant increase in psychosocial disability. Psychosocial disability can present itself in poor semantic memory, which in turn effects other cognitive domains like verbal memory and (as mentioned earlier) executive functioning leading to a direct and persisting impact on psychosocial functioning. An abnormal semantic memory organization can manipulate thoughts and lead to the formation of delusions and possibly effect speech and communication problems, which can lead to interpersonal issues. Bipolar II patients have also been shown to present worse cognitive functioning than those patients with Bipolar II, though they demonstrate about the same disability when it comes to occupational functioning, interpersonal relationships, and autonomy. This disruption in cognitive functioning takes a toll on their ability to function in the work place, which leads to high rates of work loss in Bipolar II patient populations. After treatment and while in remission, Bipolar II patients tend to report a good psychosocial functioning but they still score less in that department than normal patients without the disorder. These lasting impacts further suggest that a prolonged exposure to an untreated Bipolar II disorder can lead to permanent adverse effects on functioning.

Recovery and Recurrence Unfortunately, Bipolar II Disorder has a chronic relapsing nature. It has even been suggested that Bipolar II patients have a higher degree of relapse than Bipolar I patients. Generally, within four years of an episode, around 60% of patients will relapse into another episode. Some patients are even symptomatic half the time, either with full on episodes or symptoms that fall just below the threshold of an episode. Because of the nature of the illness, long-term therapy is the best option and aims to not only control the symptoms but to maintain sustained remission and prevent relapses from occurring. Even with treatment, patients don’t always regain full functioning, especially in the social realm. There is a very clear gap between symptomatic recovery and full functional recovery, for both Bipolar I and Bipolar II patients. As such, and because those with Bipolar II spend more time with depressive symptoms that don’t quite qualify as a major depressive episode, the best chance for recovery is to have therapeutic interventions that focus on the residual depressive symptoms and to aim for improvement in psychosocial and cognitive functioning. Even with treatment, a certain amount of responsibility is placed in the patient’s hands; they have to be able to assume responsibility for their illness by accepting their diagnosis, taking the required medication, and seeking help when needed in order to do well in the future. Treatment often lasts after remission is achieved, and the treatment that worked is continued during the continuation phase (lasting anywhere from 6-12 months) and maintenance can last 1-2 years or in some cases: indefinitely. One of the treatments of choice is Lithium, which has been shown to be very beneficial in reducing the frequency and severity of depressive episodes. Lithium prevents mood relapse and works especially well in Bipolar II patients who experience rapid-cycling. Almost all Bipolar II patients who take Lithium have a decrease in the amount of time they spend ill and a decrease in mood episodes. Along with medication, other forms of therapy have been shown to be beneficial for Bipolar II patients. A treatment called a “wellbeing plan” serves several purposes: it informs the patients, protects them from future episodes, teaches them to add value to their life, and works toward building a strong sense of self in order to fend off depression and reduce the desire to succumb to the seductive hypomania highs. The plan has to aim high enough in terms of recovery otherwise patients will relapse into depression. A large part of this plan involves the patient being very aware of warning signs and stress triggers so that they take an active role in their recovery and prevention of relapse.

Mortality Several studies have shown that the risk of suicide is higher in patients who suffer from Bipolar II than those who suffer from Bipolar I, and especially higher than patients who suffer from Major Depressive Disorder. In results of a summary of several lifetime study experiments, it was found that 24% of Bipolar II patients experienced suicidal ideation or suicide attempts compared to 17% in Bipolar I patients and 12% in Major Depressive Patients. The risk of suicide for Bipolar II patients is especially high, as many as 50% of them with attempt suicide at least once. Bipolar Disorders in general are the 3rd leading cause of death in 15-24 year olds. Bipolar II patients were also found to employ more lethal means and have more complete suicides over all. They had a higher rate of suicide attempts with a higher risk for death rather than just suicidal gestures that weren’t necessarily lethal (like self-harm). Bipolar II patients have several risk factors that increase their risk of suicide. The illness is very recurrent and results in severe disabilities, interpersonal relationship problems, barriers to academic, financial, and vocational goals, and a loss of social standing in their community, all of which increase the likelihood of suicide. Mixed symptoms and rapid-cycling, both very common in Bipolar II, are also associated with an increased risk of suicide. The tendency for Bipolar II to be misdiagnosed and treated ineffectively, or not at all in some cases, also leads to an increased risk. As a result of the high suicide risk for this group, reducing the risk and preventing attempts remains a main part of the treatment; a combination of self-monitoring, close supervision by a therapist, and faithful adherence to their medication regimen will help to reduce the risk and prevent the likelihood of a completed suicide.

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