Print a set of cards with common psychiatric and other "day-to-day" symptoms or problems on them. Examples are listed below.

You will use these as a helpful way of externalising problems, and in particular placing problems into a timeline...

It is helpful to be quite playful in these sessions, and potentially to have a digital camera to hand to photograph the visual reresentation of the crisis that you will generate.

Select which of these cards are relevant to the young person. Flick through them, as if you are playing a game of cards - show, or read out, each one, and if necessary expand on the meaning of the symptom described (this may be especially necessary for some of the symptoms of psychosis such as ideas of reference, or paranoia.) It can be helpful to have symptoms written out, as this makes asking about them less intrusive. Any cards that are rejected, as not being recognised or remembered can be tossed away in a playful way, so that what is left is a pile of symptoms that have all at one time or another been acknowledged.

You may need to have some blank cards handy to write additional symptoms on, that were not covered on the original card set.

Once you have selected the relevant cards, spread them out on the floor, and use the whole length of a room to lay out a "cascade" of symptoms, starting from the earliest things noticed, and leading up to the wide range of symptoms and signs that were apparent at the most florid part of the episode. this can take a while to arrange - typically the number of cards fans outwards as you approach the critical point (hospitalisation, attendance at A+E, Police called, etc...) and young people may find this exercise moving, educative, or upsetting.

You can photograph the finished work if the young person agrees.

Inviting family members or other trusted friends, etc, to come and examine the cascade, and perhaps to ADD any details that the young person may not have noticed, is a helpful way to develop a more systematic understanding of the difficulties, and may shed new light on the development of symptoms.

Then try to divide the timeline/cascade that you have created into three clear "phases":

• Amber - Early warning signs
• Red - Late warning signs
• Blue-light - Crisis signs

These can subsequently go towards planning your Relapse Drill, which is really a particular version of your Crisis Contingency Planning - different actions will apply (who to call, what to do, what medication to take, etc...) for each of the different stages you have identified.

Examples of useful symptoms to include:

These ones focus on Psychosis and are taken from Max Birchwood, Elizabeth Spencer and Dermot McGovern "Schizophrenia: early warning signs" Advances in Psychiatric Treatment (2000) 6: 93-101, but additional signs and symptoms can easily be added as required...

Thoughts are racing

Senses seem sharper

Thinking you have special powers

Thinking that you can read other peoples minds

Thinking that other people can read your mind

Receiving personal messages from the TV or radio

Having difficulty making decisions

Experiencing strange sensations

Preoccupied about 1 or 2 things

Thinking you might be somebody else

Seeing visions or things others cannot see

Thinking people are talking about you

Thinking people are against you

Having more nightmare

Having difficulty concentrating

Thinking bizarre things

Thinking you thoughts are controlled

Hearing voices

Thinking that a part of you has changed shape

Feeling helpless or useless

Feeling afraid of going crazy

Feeling sad or low

Feeling anxious and restless

Feeling increasingly religious

Feeling like you’re being watched

Feeling isolated

Feeling tired or lacking energy

Feeling confused or puzzled

Feeling forgetful or far away

Feeling in another world

Feeling strong and powerful

Feeling unable to cope with everyday tasks

Feeling like you are being punished

Feeling like you cannot trust other people

Feeling irritable

Feeling like you do not need sleep

Feeling guilty

Difficulty sleeping

Speech comes out jumbled filled with odd words

Talking or smiling to yourself

Acting suspiciously as if being watched

Behaviour oddly for no reason

Spending time alone

Neglecting your appearance

Acting like you are somebody else

Not seeing people

Not eating

Not leaving the house

Behaving like a child

Refusing to do simple requests

Drinking more

Smoking more

Movements are slow

Unable to sit down for long

Behaving aggressively