Prodromal symptoms to relapse in bipolar disorder Pilar Sierra, Lorenzo Livianos, Sergio Arques, Javier Castello´, Luis Rojo In a cyclical and recurring illness such as bipolar disorder, prodrome detection is of vital importance. This paper describes manic and depressive prodromal symptoms to relapse, methods used in their detection, problems inherent in their assessment, and patients’ coping strategies. A review of the literature on the issue was performed using MEDLINE and EMBASE databases (1965  May 2006). ‘Bipolar disorder’, ‘prodromes’, ‘early symptoms’, ‘coping’, ‘manic’ and ‘depression’ were entered as key words. A hand search was conducted simultaneously and the references of the articles found were used to locate additional articles. The most common depressive prodromes are mood changes, psychomotor symptoms and increased anxiety; the most frequent manic prodromes are sleep disturbances, psychotic symptoms and mood changes. The manic prodromes also last longer. Certain psychological interventions, both at the individual and psychoeducational group level, have proven effective, especially in preventing manic episodes. Bipolar patients are highly capable of detecting prodromal symptoms to relapse, although they do find the depressive ones harder to identify. Learning detection, coping strategies and idiosyncratic prodromes are elements that should be incorporated into daily clinical practice with bipolar patients. Key words: bipolar disorder, coping, depression, early symptoms, mania, prodromes. Australian and New Zealand Journal of Psychiatry 2007; 41:385  391 Becauseofitscyclicalandrecurringnature,bipolar disorderisaseriousillnessthatcausesdifferinglevels of hardship to an important number of patients. Since the introduction of lithium, which has proven effective beyond any doubt in the prevention of manic and to a lesser degree depressive episodes, in thelastfewyearsnewmoodstabilizershaveappeared topreventrelapseandrecurrenceinbipolardisorder. The ideal mood stabilizer, however, has still to be found. Work should, therefore, continue on other methods of relapse control. Earlydetectionbypatientsofthefirstsymptomsor signs of relapse, called prodromes, is one very importantsuchmethod.Thedurationofaprodrome isdefinedasthetimeintervalbetweentherecognition of the first symptom and the moment when the symptoms of an episode are at their most intense [1,2]. There are different ways of categorizing them, for example as behavioural, psychological, cognitive, affective or idiosyncratic [3  6]. The ability to detect prodromesispartoftheconceptofinsight.Insightis not an all-or-nothing construct but consists of three components: recognition that one has a mental illness; compliance with treatment; and the ability to relabel unusual mental events as pathological [7]. Adequateinsightmayallowapatienttobetterhandle their illness and can influence their functioning [8]. In psychiatry, research on prodromes was initially directed to the field of schizophrenia, with the objective of making possible early therapeutic inter- ventionandpreventingthefirststagesfrombecoming full-blown episodes. In 1980, Herz and Melville did Pilar Sierra, Psychiatrist (Correspondence) Psychiatric Unit, Hospital La Fe, Avda Campanar n821, 46009 Valencia, Spain. Email: sierra_pil@gva.es Lorenzo Livianos, Associate Professor Bipolar Disorders Program; Sergio Arques, Psychiatrist Trainee; Javier Castello ´, Psychiatrist Trainee; Luis Rojo, Associate Professor Department of Psychiatry, Hospital La Fe, Valencia, Spain Received 14 November 2006; accepted 17 January 2007. # 2007 The Royal Australian and New Zealand College of Psychiatrists