[Manic polarity of the onset episode of bipolar disorder: clinical and prognostic considerations].

Studies mapping the course of bipolar disorder from the first episode have provided important information with regard to the prognosis of the illness in patients with a manic episode at onset. Two different approaches have been used in these studies. Prospective follow-up studies conducted in the few years following the first episode have emphasized the poor symptomatic and functional short-term outcome of the patients. Retrospective studies, more relevant to address the long-term course of the illness according to the clinical characteristics of the first episode, have consistently evidenced that polarity at onset is predictive of the dominant polarity of the disorder for a given patient. Given the harmful consequences of recurrences on the outcome of the illness and the psychosocial functioning of patients, early diagnosis potentially allowed by the occurrence of a first manic episode is a critical step toward prescribing a mood stabilizer at the beginning of the disorder. Accurate knowledge on the clinical characteristics and the course of illness in patients with a manic episode at illness onset may help clinicians for developing more specific and more relevant therapeutic intervention for these patients.