Helping with bipolar warning signs

Becoming hypomanic or manic

When combined with the person’s usual bipolar medication, recognizing and responding to bipolar warning signs can help prevent bipolar relapse, especially mania or hypomania. 1

Many people with bipolar disorder experience warning signs of bipolar episodes (see examples of bipolar warning signs) . However, they may not always be aware of these changes.2 Caregiver assistance with managing bipolar warning signs may help to prevent bipolar relapse.3

Below is some information about how to help with bipolar warning signs including:

  • Knowing the person’s bipolar warning signs
  • Identifying bipolar warning signs when they occur
  • Communicating with the person about bipolar warning signs
  • Ways to help when bipolar warning signs or early bipolar symptoms appear
  • If the person has signs of mania or hypomania
  • If the person has signs of bipolar depression

If the person does not want help with bipolar warning signs, noticing these bipolar signs can make it easier for you to understand the person’s behavior and plan how to respond to it.

Knowing the person’s bipolar warning signs

To get to know the person’s typical warning signs:

  • Find out about common and individual bipolar warning signs so you know what to look out for.
  • Ask the person about their warning signs and what they do when these occur.
  • You may have noticed certain warning signs that appeared before the person became ill in the past.
  • Some people with bipolar disorder and caregivers find it helpful to keep a list of the person’s warning signs.

Identifying bipolar warning signs when they occur

Be alert to changes in the person’s usual behavior and thinking.

Everyday emotions such as joy, sadness or disapointment need to be distinguished from bipolar moods:

  • Bipolar moods last longer and are harder to change than everyday emotions.
  • Bipolar moods are more intense and cause more changes or disruption to the person’s daily life.
  • Bipolar moods may be unrelated to good or bad things happening around the person. Everyday joy or sadness is often related to actual events.

If the person already has mild ongoing bipolar symptoms, be alert to changes that signal that the person is becoming more ill or developing new symptoms. It is important to keep an eye on mild ongoing symptoms between episodes, as they increase the person’s risk of relapse. However, be careful not to constantly question everything the person says and does for signs of illness, or it may be difficult for them to enjoy the times when they are well.

Communicating with the person about their bipolar warning signs

Discussing bipolar warning signs with the person can be a sensitive issue. Misinterpreting mood fluctuations and behavior that are common to us all as part of bipolar disorder can be hurtful and frustrating.

  • Talk to the person when they are well about how they would prefer you to communicate when you have noticed warning signs of illness.
  • Let them know what bipolar warning signs you have noticed as soon as possible, as there is a greater chance of preventing relapse if the person deals with their warning signs early.
  • Inquire if the person has noticed the changes that you have observed, and if they could be warning signs of illness.
  • Express your concerns in a way that is non-judgmental and unthreatening (e.g. “I have noticed that you have been a bit down lately”).
  • If the behavior you have noticed occurred in a previous bipolar episode, remind the person about this, and explain that this is the reason for your current concern.
  • If you are unsure whether something is a bipolar warning sign, discuss this possibility with the person.

Ways to help when bipolar warning signs appear

The way to support the person can depend on the type of warning signs they are experiencing:

Below are more tips you might find useful:

  • When warning signs appear avoid getting caught up in the person’s bipolar mood state (e.g. in the excitement or irritability of the person’s growing hypomania).
  • If the person has bipolar warning signs and does not want to see a clinician, negotiate with them to agree to get clinical help if things don’t improve or get worse within a set time.
  • Monitoring warning signs can help to see if they subside or get worse.
  • If the person is anxious about becoming ill, reassure them that they can deal with the illness and that you are available to support them.
  • For more about working with the person on bipolar management and difficulties that sometimes arise see working together.

Community and health services in your area may be able to provide additional training if you want to know more about how to help with bipolar warning signs.

References

  1. Perry A, Terrier N, Morris R, McCarthy E, & Limb K. A randomized controlled trial of the efficacy of teaching patients with bipolar mood disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999; 318 :149-153.
  2. Dias V, Brissos S, Carita A. Clinical and neurocognitive aspects of lack of insight in euthymic bipolar patients. Acta Psychaitr Scand 2008; 117(1) :28-34.
  3. Reinares M, Colom F, Sanchez-Moreno J, et al. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trail. Bipolar Disord 2008; 10 :511-19.

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