A polyepisodic course in bipolar illness: possible clinical relationships.

Using archival data, we conducted a systematic study of consecutive admissions of bipolar patients and found that an early age of onset, a subacute onset, a family history of bipolarity, and the administration of electroconvulsive therapy (ECT) during an index episode were individually associated with a polyepisodic course of illness (three to nine or more episodes) during a period of observation which included onset of illness, index admission, and a period of follow-up. The family history of biopolarity which seems to predispose to multiple episodes suggests that what may be transmitted may not necessarily be a bipolar illness but possibly an illness with many episodes, thus increasing the likelihood of occurrence of a manic episode.