| Bipolar disorder is a chronic and disabling illness with significant social, occupational, and financial burdens. Considerable implications would result from a clear understanding of the course of this illness. The program of research presented focused on the role of episodic and chronic stress on the course of bipolar disorder, with particular attention to identifying polarity-specific predictors of depression or mania. Method. Data from two distinct studies were utilized in the chapters presented. The first was a sample of 55 outpatients recruited while in remission. The second study was a sample of 65 participants recruited during a hospitalization for a manic episode. Results. Findings suggest polarity-specific effects of expressed emotion on depressive, but not manic, recurrence. Additionally, chronic stress was a polarity-specific predictor of depressive recurrence. Although episodic stress was a predictor of recurrence, it was not a polarity-specific predictor. Sleep and social rhythm disruption were not significant moderators of the relationship between stress and recurrence. When examining predictors of the course of recovery from hospitalization from mania, several interesting findings emerged. Overall, a larger percentage of participants achieved functional recovery than expected. Recovery was attained in numerous domains, including interpersonal, home, and work. Moreover, the majority of participants attained functional recovery immediately upon symptomatic recovery status. Lower frequency and severity of episodic stress predicted immediate versus delayed functional recovery. The results of the three presented chapters help to clarify the relationship between stress and the course of bipolar disorder. Conclusions. Stress plays an important and polarity-specific role in the course of bipolar disorder. Limitations include small sample sizes, proxy measures of sleep and social rhythm disruption, and limited follow-up periods. Strengths include the prospective design, objective assessment of stress, consideration polarity-specific differences, and focus on the course of functional recovery. Treatment should include careful examination of ongoing stressors, particularly in participants at high risk for depressive recurrence. Acute stressors appear to be related to the timing of functional recovery following a severe manic episode. |
