Indian Journal of Psychological Medicine
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Year : 2008  |  Volume : 30  |  Issue : 2  |  Page : 67 Table of Contents   

"Signature" relapse

Asha Hospital, Hyderabad, India

Correspondence Address:
M S Reddy
Asha Hospital, Hyderabad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0253-7176.48473

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How to cite this article:
Reddy M S. "Signature" relapse. Indian J Psychol Med 2008;30:67

How to cite this URL:
Reddy M S. "Signature" relapse. Indian J Psychol Med [serial online] 2008 [cited 2020 Jun 4];30:67. Available from:

Bipolar Affective Disorder (BPAD) is a chronic illness with remission/recovery and relapse/recurrence . The goal of treatment is, more often than not, directed at prevention of future episodes - Prophylaxis or Mood stabilization. Despite voluminous literature and numerous "Mood stabilizers", effective mood stabilization is mostly elusive. The next best thing for the clinician is to develop tools for early, preferably very early, identification of relapse or recurrence. This is easier said than done. One useful observation is that a particular patient shows a specific symptom as an early sign of relapse or recurrence of the next episode.

   Signature Symptoms of Relapse for Particular Patients Top

One patient's wife reports that the earliest sign of relapse of a manic episode in her husband is a sudden increase in the desire for more frequent sexual activity, especially during the day.

The father of a lady patient explains that the earliest sign of a relapse in his daughter is her taking a bath every day, which otherwise is usually once in two to three days.

The wife of another patient narrates that the day her husband starts talking in English she is sure that he is going into another manic episode.

Drug abuse, as we are all well aware, is a common symptom in BPAD. Some patients show a clear episodic pattern in substance abuse and Dipsomania. A sudden start or restart of smoking or an increase in consumption of alcohol can sometimes be an early warning sign of an impending relapse.

A young patient of mine, working in the US, was able to specifically highlight that during the months of November and December of every year he used to develop a sudden craving for smoking marihuana, which used to last for two months, after which he remained totally abstinent for the next 10 months. Furthermore, this pattern has been continuing for the last four years.

Another patient, who had seven depressive episodes in the last 12 years, presents with a sudden onset of a symptom of a fear of dogs and an obsessive thought about having rabies. This pattern of obsessive thought, in association with the phobic symptom, was episodic, with total recovery in the inter-episodic period.

This signature relapse symptom may not be present in all the patients. However, in those patients where it exists, elicitation of this symptom demands a keen clinical sense of the treating psychiatrist and also the observational skills of the patient and his/her relatives. A good rapport in the therapeutic relationship is helpful. Whenever present, this "signature symptom" provides an excellent opportunity for early diagnosis of the episode, thereby extending the benefit of early, and hopefully, effective treatment. Moreover, the violence or disruptiveness of a manic, or the deliberate self-harm of a depressive may be averted, and hospitalizations can be less frequent.

There is no denying the objective validity of diagnostic criteria and rating scales. Although, common sense with a keen observatory skill adds to the fine-tuning of your clinical acumen, which I am afraid is taking a back seat in these days of evidence-based medicine.


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