Bipolar illness

Background. Within the past 5 years, several factors have altered our view of the diagnosis, prognosis, treatment, and genetics of bipolar illness. Methods. Significant advances in these areas are reviewed. Results. Diagnostic changes include establishment of symptom duration requirements that limit confusion with affective instability. Prognostic insights include the realization that illness likely begets illness and, conversely, that adequate control is probably instrumental in improving long-term prognosis. Therapeutic advances are marked by the Food and Drug Administration approval of divalproex for acute mania. Conclusions. Genetic and family studies suggest that (1) bipolar illness is a discrete condition, not related to unipolar depression; and (2) bipolar illness may manifest a phenomenon known as anticipation (worsening of the disease with succession generations), which may be related to a specific nucleic acid abnormality.