Unit 4 is devoted to teaching patients how to identify a relapse, take prompt action from the behavioral standpoint, and work out an emergency drug treatment plan. Early detection of relapses is a technique that has already been discussed, especially in individual format, and many of our patients benefit from its being built into a group psychoeducation program.

Perhaps the best study on individual psychological intervention in bipolar disorders is the one by Perry et al. (1999); the type of intervention was a variable number of sessions, between 7 and 12, in which the therapist used a distinctly psychoeducative approach in helping patients to identify their most habitual relapse signals. The results indicate that the patients in the treatment group (N = 34) took longer to experience a manic relapse and, at the end of the follow-up period, had a smaller number of manic relapses than the control group (N = 35). It seems that there was no prevention effect for depressive episodes.

In our program we place special emphasis on early detection of hypomanic and manic symptoms for various reasons, most important of which are:

• The speed with which hypomania warning signs (“prodromes”) become a full-blown episode is far greater than in the case of depression. While in depression several weeks usually elapse between the first warning signs and the actual episode, in the case of hypomania and manic this can happen in a matter of days or hours.