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However, previous studies may be biased towards hospitalized patients with bipolar I disorder (<jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I), and generalizability to the current treatment era remains uncertain. In this naturalistic study, we followed a secondary\u2010care cohort of patients with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In the Jorvi Bipolar Study, 191 patients with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I and bipolar <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> disorder (<jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>) were followed using a life\u2010chart method. Interviews were conducted at six months, 18\u00a0months, and five years. Time to full remission, time to first recurrence, total time ill, their predictors, and <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I versus <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> differences were investigated among the 151 patients remaining in follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2010third 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 <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I and <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> persisted. Among patients with a depressive index phase, cluster C personality disorders [hazard ratio (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>)\u00a0=\u00a00.452, p\u00a0=\u00a00.040] and higher 17\u2010item Hamilton Depression Scale score (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\u00a0=\u00a00.951, p\u00a0=\u00a00.022) predicted longer time to remission, whereas lifetime psychotic symptoms (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\u00a0=\u00a02.162, p\u00a0=\u00a00.016) predicted shorter time to first recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among patients with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>, chronicity as uninterrupted persistence of illness was rare, but multiple recurrences were the norm. Patients with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content> spent only half of their time euthymic. Patients with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I and <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> may differ little in proneness to depressive states. Severity of depression, cluster C personality disorders, and psychotic symptoms predicted outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12291","type":"journal-article","created":{"date-parts":[[2015,3,2]],"date-time":"2015-03-02T06:38:58Z","timestamp":1425278338000},"page":"363-374","source":"Crossref","is-referenced-by-count":44,"title":["Five\u2010year outcome of bipolar I and II disorders: findings of the Jorvi Bipolar Study"],"prefix":"10.1111","volume":"17","author":[{"given":"Sanna","family":"Pallaskorpi","sequence":"first","affiliation":[{"name":"Department of Mental Health and Substance Abuse Services National Institute of Health and Welfare Helsinki Finland"},{"name":"Psychiatric and Substance Abuse Services Helsinki City Department of Social Services and Healthcare Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsi","family":"Suominen","sequence":"additional","affiliation":[{"name":"Department of Mental Health and Substance Abuse Services National Institute of Health and Welfare Helsinki Finland"},{"name":"Psychiatric and Substance Abuse Services Helsinki City Department of Social Services and Healthcare Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Ketokivi","sequence":"additional","affiliation":[{"name":"Operations and Technology Department IE Business School\u2013IE University Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Outi","family":"Mantere","sequence":"additional","affiliation":[{"name":"Department of Mental Health and Substance Abuse Services National Institute of Health and Welfare Helsinki Finland"},{"name":"Department of Psychiatry Helsinki University Central Hospital Helsinki Finland"},{"name":"Department of Psychiatry University of Helsinki Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petri","family":"Arvilommi","sequence":"additional","affiliation":[{"name":"Department of 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