Bipolar disorder is a severe mental disorder associated with high levels of personal and societal burden. Although several pharmacological and non-pharmacological interventions have been developed and are currently available in the routine the long-term treatment of bipolar patients, the rate of functional recovery is not very satisfying yet. Many unmet needs are still present in the optimal management of bipolar patients, including diagnostic, clinical and therapeutic challenges.  New perspectives are emerging for improving the clinical and functional outcomes of patients suffering from bipolar disorder. In particular, it has been recently argued that the optimal management of bipolar patients requires the evaluation of patient’s personal history according to a longitudinal perspective. In this conceptual framework, the construct of predominant polarity has been proposed by Colom for describing the predominant type of affective episodes according to a lifetime perspective. The predominant polarity has several therapeutic and prognostic implications for the long-term management of bipolar patients. Furthermore, neuroimaging correlates have recently confirmed the prognostic role of predominant polarity, highlighting the relevance of such index from a clinical perspective. In this symposium, the role of neuroimaging correlates of predominant polarity will be presented. Moreover, further new perspectives in the field of research in bipolar disorder are recently focusing on the role of childhood maltreatment and expression of symptoms during childhood as relevant predictors of long-term outcome. There is the need to translate the model of early interventions to the context of affective disorders, in order to significantly improve the long-term outcome of bipolar patients.