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Bipolar disorders are longlasting and usually lifelong diseases. This review gives a comprehensive overview concerning its outcome and prognosis. Such aspects as onset, cycle length, course predictors, occurrence of persisting alterations, disability, mortality and comorbidity are being discussed. A special emphasis is given to atypical aspects of bipolar illness such as rapid cycling, mixed episodes, seasonality and bipolar schizoaffective disorder. To a great extent, the course of bipolar affective disorders seems to be biologically determined. The knowledge concerning such determining factors is limited, so that until now prediction of future course and outcome for a single subject is difficult.