TREATMENT OF SYMPTOM EXACERBATIONS (see algorithm)

It is not uncommon for patients who have been in remission to have exacerbations of symptoms. This may remain at a subthreshold level or, commonly, herald a full blown episode of a mood disorder. Patients and families/support networks need education and training to recognize symptoms exacerbations. Patients may not recognise symptom exacerbations and may depend on supportive family, friends or clinicians to do so. Patients should have rapid access to reassessment. Identifying and managing psychosocial precipitants or stressors, ensuring adequate sleep, dealing with alcohol and substance abuse, ensuring optimum serum levels of medication and ruling out adverse drug-drug interactions are important. Non-responders to these measures may require the addition of other relevant biological and psychosocial interventions to produce a remission and prevent the entry into another acute illness phase.