This review shows a beneficial effect of EWS in time to recurrence , percentage of people hospitalised and functioning in people with bipolar disorder .
BACKGROUND Recurrence rates for bipolar disorder are high despite effective treatments with mood stabiliser drugs .
Self-help treatments and psychological treatments that teach patients to recognise and manage early warning symptoms and signs ( EWS ) of impending manic or depressive episodes are popular with patients .
The main aim of such interventions is to intervene early and prevent bipolar episodes , thereby increasing the time to the next recurrence and preventing hospitalisation .
OBJECTIVES To compare the effectiveness of an EWS intervention plus treatment as usual ( TAU ) versus TAU ( involving and not involving a psychological therapy ) on time to manic , depressive and all bipolar episodes ( the primary outcome ) , hospitalisation , functioning , depressive and manic symptoms .
Subsyndromal symptoms in bipolar disorder. A comparison of standard and low serum levels of lithium.
Ninety-four patients with bipolar disorder participating in a r and om-assignment , double-blind , prospect i ve maintenance trial of st and ard- ( 0.8 to 1.0 mmol/L ) vs  low-range ( 0.4 to 0.6 mmol/L )  serum lithium levels  were assessed to determine the presence and significance of subsyndromal symptoms during periods of remission and recovery . A significant relationship was found between prescribed serum lithium level and the probability of major affective relapse and the occurrence of subsyndromal symptoms . Patients given lithium carbonate to achieve low-range levels had 2.6 times the risk of major affective relapse as those given lithium for st and ard-range levels and nearly twice the risk of developing subsyndromal symptoms . Patients given the low-range therapy showed a greater variance in weekly Psychiatric Status Rating measures , and their symptoms were more likely to worsen at any time than were symptoms in their st and ard-level group counterparts . The first occurrence of subsyndromal symptoms increased the risk of major affective relapse fourfold . Following the onset of subsyndromal symptoms , the patients originally r and omized to receive st and ard-range lithium therapy were still better protected from relapse than were patients r and omized to receive low-range lithium treatment . Patients were two times more likely to develop depressive than hypomanic symptoms between acute episodes of illness . However , onset of hypomanic symptoms predicted subsequent major affective relapse twice as strongly as did depressive symptoms . Seventy-six percent of patients who became hypomanic had a major affective relapse , compared with 39 % of patients who were sub clinical ly depressed
This review shows a beneficial effect of EWS in time to recurrence , percentage of people hospitalised and functioning in people with bipolar disorder .
BACKGROUND Recurrence rates for bipolar disorder are high despite effective treatments with mood stabiliser drugs .
Self-help treatments and psychological treatments that teach patients to recognise and manage early warning symptoms and signs ( EWS ) of impending manic or depressive episodes are popular with patients .
The main aim of such interventions is to intervene early and prevent bipolar episodes , thereby increasing the time to the next recurrence and preventing hospitalisation .
OBJECTIVES To compare the effectiveness of an EWS intervention plus treatment as usual ( TAU ) versus TAU ( involving and not involving a psychological therapy ) on time to manic , depressive and all bipolar episodes ( the primary outcome ) , hospitalisation , functioning , depressive and manic symptoms .