When the patient is in a stable condition, it is mandatory to establish an oral contract that elicits big/her cooperation in permitting a trusted
significant person to make an intervention. The patient grants the person permission to intervene to prevent an episode by:

1. Giving feedback regarding the patient's thinking, mood and behavior.

2. Calling the patient's doctor to arrange an appointment or to discuss treatment.

3. Modifying the living situation to reduce stimulation.

'4. Providing consistent, structured and supportive reassurance.

When you notice hypomanic symptoms in your family member or friend please remember to:

1. Remain calm; do not panic or criticize.

2. Make statements rather than ask questions. Instead of asking, "Are you getting high again?" say something like "You are wound up and seem preoccupied. Let's talk about it." If you meet resistance, don't push;
remind the patient of the contract.

3. Discuss with the patient the fact that he has a choice and options. He can choose to avoid an episode or allow it to escalate and run its course with' the probability of hospitalization and the loss of many present gains.

4. Make positive suggestions to:

a. Review activities and decrease schedule by one-third for at least 7 to10 days.

b. Reduce stimulation (loud music, noise, light. talking, violent movies, etc.). Enforce a quiet environment no visitors, celebrations). Maintain planned. low-key days.

c. Regulate sleep--no naps--try to adhere to "normal" sleep patterns.

d. Monitor medication intake. Increase medication with doctor's advice. Get serum level if on lithium, and keep appointments to see doctor.

e Reassure patient that if he follows these steps, in a few days, the episode may be aborted.

f. Be positive in attitude and actions. Use your sense of humor. Suggest to the patient that he has internal control to help regulate the way be thinks, feels and behaves.

g. When you have achieved success with this episode, con-granulate yourself and the patient. Mark the date on the calendar and write down what you observed and what you did to modify it.

-Dr. Julia Mayo, SL Vincents Hospital, NYC

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