Bipolar relapse prevention worksheet

Recognizing early warning signs of bipolar disorder relapse can be an effective self-management strategy for clients with bipolar disorder. 

This article provides an overview of bipolar relapse signatures and potential triggers to help clients identify and recognize early warning signs. We’ve also included a free downloadable bipolar relapse prevention worksheet that you can save to your electronic health record (EHR) and use in your practice. 

What is bipolar disorder?

Bipolar disorder is a treatable mental health condition that affects an estimated 2.8% of U.S. adults each year—roughly 7 million people.

Bipolar disorder involves dramatic shifts in mood, energy, activity levels, and emotional states. Some people might appear extremely energetic or “up” (characterized as a manic episode) or very down or sad (a depressive episode). These shifts are more extreme than everyday mood fluctuations and can have a significant impact on a person’s day-to-day life.

Bipolar relapse rates are notably high—according to the DSM-5, more than 90% of people who experience a single manic episode go on to have recurrent mood episodes over their lifetime. However, medication and psychosocial interventions, such as relapse prevention, are effective in reducing the risk of recurrence. 

For more information on the symptoms and types of bipolar disorder, check out our detailed article, What is bipolar disorder? For diagnostic information, our ICD-10 bipolar disorder coding guide may also be helpful.

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What are bipolar relapse signatures?

Bipolar relapse signatures are early warning signs that a person may be experiencing a recurrence of symptoms or a mood episode. By recognizing these early indicators, individuals and clinicians can prevent relapse and provide early intervention to avoid adverse outcomes. 

Research suggests that interventions that focus on improving recognition of relapse signatures and self-management are effective in delaying depressive or manic episodes.

While warning signs are specific to the individual, they may include:

• Changes in sleeping patterns: These might include an increased need for sleep, indicating a potential depressive episode, or a decreased need for sleep, which may indicate the recurrence of a manic or hypomanic episode.

• Mood fluctuations: Early warning symptoms include a pattern of increased irritability, frustration, hopelessness, or feeling overstimulated, which often precede the more dramatic shift in moods associated with a relapse.

• Shifts in energy levels: Excessive energy or restlessness may be a sign of a manic episode, while fatigue or feeling low energy may be a warning sign of a depressive episode. 

• Social withdrawal: Early warning signs include changes in social patterns, such as withdrawing from socializing, a loss of interest in people, or an increase in socializing that may lead to risk-taking behaviors.

• Cognitive changes: These may include difficulty concentrating, changes in thought patterns, a lack of insight, increased confidence, or difficulty remembering.

• Suicidal thoughts: Early warning signs include suicidal ideation, thoughts of being better off dead, or thoughts of self-harm. If a client discloses suicidal ideation or intent, follow your practice's safety planning protocol and assess risk accordingly. The 988 Suicide & Crisis Lifeline (call or text 988) is also a resource to share with clients between sessions. 

Bipolar relapse triggers

Just like early warning signs, bipolar relapse triggers differ from person to person. However, they may include:

• Changes to medication

• Stressful life events

• Lack of sleep or sleep disturbance, such as jet lag

• Substance use

• Lack of routine or changes to regular activities

• Seasonal changes

• Stimulating sensory inputs, like loud music, crowds, and bright lights

• Conflict

• Life transitions

• Pregnancy

• Grief and loss

How to use the bipolar relapse prevention worksheet

You can download and use the bipolar relapse prevention worksheet in several ways:

• Use the worksheet to provide psychoeducation about bipolar relapse triggers and symptoms.

• Give the client a copy of the relapse prevention plan to remind them of bipolar relapse symptoms to look out for and their coping strategies.

• Share the worksheet with coworkers.

• Use the bipolar relapse prevention worksheet to provide training to interns or supervisees.

• Use the worksheet in group therapy sessions.

• Combine the bipolar relapse signatures worksheet with other bipolar and mood worksheets and handouts, such as our daily mood chart, bipolar disorder handout, or bipolar mood chart.

Sources

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

• Morriss, R. K., Faizal, M. A., Jones, A. P., Williamson, P. R., Bolton, C., & McCarthy, J. P. (2007). Interventions for helping people recognise early signs of recurrence in bipolar disorder. The Cochrane Database of Systematic Reviews. 

• National Institute of Mental Health. (n.d.). Bipolar disorder. U.S. Department of Health and Human Services, National Institutes of Health. 

• Perlis, R. H., Ostacher, M. J., Patel, J. K., Marangell, L. B., Zhang, H., et al. (2006). Predictors of recurrence in bipolar disorder: primary outcomes from the systematic treatment enhancement program for bipolar disorder (STEP-BD). American Journal of Psychiatry. 

• Prada, A. (2024). What are bipolar disorders? American Psychiatric Association.

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