Original Article Five-year outcome of bipolar I and II disorders: findings of the Jorvi Bipolar Study Pallaskorpi S, Suominen K, Ketokivi M, Mantere O, Arvilommi P, Valtonen H, Lepp€ am€ aki S, Isomets€ a E. Five-year outcome of bipolar I and II disorders: findings of the Jorvi Bipolar Study. Bipolar Disord 2015: 00: 000–000. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Objectives: The long-term outcome of bipolar disorder (BD) has been extensively investigated. However, previous studies may be biased towards hospitalized patients with bipolar I disorder (BD-I), and generalizability to the current treatment era remains uncertain. In this naturalistic study, we followed a secondary-care cohort of patients with BD. Methods: In the Jorvi Bipolar Study, 191 patients with BD-I and bipolar II disorder (BD-II) were followed using a life-chart method. Interviews were conducted at six months, 18 months, and five years. Time to full remission, time to first recurrence, total time ill, their predictors, and BD-I versus BD-II differences were investigated among the 151 patients remaining in follow-up. Results: Nearly all subjects recovered from the index episode, but almost all (90%) had a recurrence, and most had multiple recurrences. The patients spent about one-third of their time in illness episodes and 15% of their time with subthreshold symptoms; half of the time they were euthymic. After controlling for confounders, no difference in time spent in depressive states between patients with BD-I and BD-II persisted. Among patients with a depressive index phase, cluster C personality disorders [hazard ratio (HR) = 0.452, p = 0.040] and higher 17-item Hamilton Depression Scale score (HR = 0.951, p = 0.022) predicted longer time to remission, whereas lifetime psychotic symptoms (HR = 2.162, p = 0.016) predicted shorter time to first recurrence. Conclusions: Among patients with BD, chronicity as uninterrupted persistence of illness was rare, but multiple recurrences were the norm. Patients with BD spent only half of their time euthymic. Patients with BD-I and BD-II may differ little in proneness to depressive states. Severity of depression, cluster C personality disorders, and psychotic symptoms predicted outcome. Sanna Pallaskorpi a,b , Kirsi Suominen a,b , Mikko Ketokivi c , Outi Mantere a,d,e , Petri Arvilommi a,b , Hanna Valtonen a,b , Sami Lepp € am € aki d,f and Erkki Isomets € a a,d,e a Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, b Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland, c Operations and Technology Department, IE Business School–IE University, Madrid, Spain, d Department of Psychiatry, Helsinki University Central Hospital, e Department of Psychiatry, University of Helsinki, f Finnish Institute of Occupational Health, Helsinki, Finland doi: 10.1111/bdi.12291 Key words: bipolar disorder – cohort studies – outcome – recurrence – remission Received 12 September 2014, revised and accepted for publication 5 November 2014 Corresponding author: Professor Erkki Isomets€ a Department of Psychiatry Institute of Clinical Medicine University of Helsinki P.O. Box 22 Helsinki 00014 Finland Fax: +358-9-47163735 E-mail: erkki.isometsa@hus.fi Bipolar disorder (BD) is a recurrent, pleomorphic, and often chronic illness usually causing a lifelong burden for affected individuals (1). Whether or not the illness is progressive and evolves in stages (2, 3) remains uncertain. Given the major public health relevance of BD, the importance of long-term prognosis for both patients and health care sys- tems, and the fundamental nature of questions related to illness progression, it is unsurprising that numerous studies have investigated the long-term outcome of BD. The largest prospective study, the US Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), had a follow-up period of two years (4). Overall, published long- term prospective naturalistic studies (5–21) and a long-term follow-up study of group psychoeduca- tion (22) have provided invaluable insights into illness course, verifying the recurrent and often 1 Bipolar Disorders 2015 © 2015 John Wiley & Sons A/S Published by John Wiley & Sons Ltd. BIPOLAR DISORDERS