Der Krankheits-Verlauf bipolarer Störungen und manischer Erkrankungen ist individuell sehr verschieden! Trotz der dargestellten prädisponierenden genetischen Faktoren ist das Krankheitsgeschehen multifaktoriell begründet. Menschen erkranken aus unterschiedlichen Gründen, sind unterschiedlich stark betroffen und gehen mit ihrer Erkrankung auch individuell sehr verschieden um! In Fällen moderater Ausprägung kann ein „hyperthymes Temperament“ mit besonderer Kreativität verbunden sein und evolutionsbiologisch einen Überlebensvorteil darstellen.

Bipolare Störungen sind wesentlich seltener als monopolare Störungen. Ihre Prognose ist aber ungünstiger. Besonders ungünstig ist die Prognose bei Patienten mit einem „rapid cycling“.

In 50% der Fälle kommt es in den Krankheitsphasen zu psychotischen Wahrnehmungsverzerrungen.

Es gilt als gesichert, dass mehr als drei Viertel aller Menschen, die an einer bipolaren Störung leiden, mehr als einen Zyklus erleben werden. Die Zykluslänge umfasst bei den bipolaren Störungen etwa 1-2 Jahre.

Bei bipolaren Störungen macht die Manie im Durchschnitt nur 10-20% der Krankheitsphasen aus, deutlich überwiegend sind in aller Regel die depressiven Phasen. Im Mittel kommt es zu acht Krankheitsphasen.

20-30% d. Fälle heilen nicht oder nicht vollständig aus, sondern nehmen einen chronifizierenden Verlauf. Von Chronifizierung spricht man ab einer Verlaufsdauer von 2 Jahren.

Im Rahmen depressiver Zustände bei bipolaren Störungen, insbesondere bei heimtückisch einschiessenden depressiven Verstimmungen besteht eine deutlich erhöhte Suizidalität, die mit 15-30% sogar erheblich über der bei monopolaren Depressionen liegt!

Ebenfalls höher als bei monopolaren Depressionen ist die Rate des Alkohol-, Medikamenten- und Drogenmißbrauchs bei bipolaren Störungen.

Verlauf und Prognose der Hypomanie und Manie

Reine Hypomanien und Manien sind eher selten. Hypomanien finden sich auch als Persönlichkeitsakzentuierung. Die Prognose ist abhängig vom Ausprägungswgrad, d. h. v. a. davon, wie gesellschaftsschädlich die Symptomatik ist. Da sich die Betroffenen in manischen Phasen meist gut fühlen, besteht ein deutlich geringerer subjektiver Behandlungsbedarf, weniger Krankheitseinsicht und wohl auch, von schweren Verlaufs-Formen abgesehen, eine deutlich bessere Prognose.

Verlauf und Prognose der Zyklothymie

In 15 – 50% geht die Störung in eine Bipolar-I-Störung oder eine Bipolar-II-Erkrankung über oder kommen gleichzeitig mit solchen Störungen vor. Häufig entwickelt sich im Krankheits-Verlauf ein verkomplizierender Substanz-Missbrauch. Wegen des frühen Beginns besteht im Krankheits-Verlauf die Gefahr der Entwicklung erheblicher sozialer und beruflicher Defizite, wenn eine umfangreiche Rehabilitation nicht gelingt. Die Prognose ist daher zweifelhaft.

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