Skip to main content

Advertisement

SpringerLink
Log in

Sequential behavioral treatment of smoking and weight control in bipolar disorder

  • Case study
  • Published:
Translational Behavioral Medicine

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

ABSTRACT

People with severe mental illnesses like schizophrenia and bipolar disorder (BPAD) live significantly shorter lives than people in the general population and most commonly die of cardiovascular disease (CVD). CVD risk behaviors such as smoking are not routinely assessed or assertively treated among people with a severe mental illness. This article provides an illustrative case example of a woman with BPAD who is motivated to quit smoking, despite concerns about weight gain and relapse to depression. It outlines key considerations and describes the patient’s experience of participating in a behavioral intervention focussing first on smoking, then diet and physical activity. Clinical challenges encountered during treatment are discussed in the context of relevant literature. These include motivational issues, relapse to depression, medication interactions, weight gain, addressing multiple health behavior change, focussing on a behavioral rather than cognitive approach, collaborating with other health care providers, and gender issues.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Newcomer JW. Metabolic syndrome and mental illness. Am J Manag Care. 2007;13:S170-S177.

    PubMed  Google Scholar 

  2. Bresee LC, Majumdar SR, Patten SB, Johnson JA. Prevalence of cardiovascular risk factors and disease in people with schizophrenia: a population-based study. Schizophr Res. 2010;17:75-82.

    Article  Google Scholar 

  3. Miller BJ, Paschall CB, Svendsen DP. Mortality and medical comorbidity among patients with serious mental illness. Psychiatr Serv. 2006;57:1482-1487.

    Article  PubMed  Google Scholar 

  4. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006;3:A42.

    PubMed  Google Scholar 

  5. Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34–38 years. J Affect Disord. 2002;68:167-181.

    Article  PubMed  CAS  Google Scholar 

  6. Hennekens CH. Increasing global burden of cardiovascular disease in general populations and patients with schizophrenia. J Clin Psychiatry. 2007;68:4-7.

    Article  PubMed  Google Scholar 

  7. Birkenaes AB, Opjordsmoen S, Brunborg C, et al. The level of cardiovascular risk factors in bipolar disorder equals that of schizophrenia: a comparative study. J Clin Psychiatry. 2007;68:917-923.

    Article  PubMed  Google Scholar 

  8. Correll CU, Frederickson AM, Kane JM, Manu P. Equally increased risk for metabolic syndrome in patients with bipolar disorder and schizophrenia treated with second-generation antipsychotics. Bipolar Disord. 2008;10:788-797.

    Article  PubMed  Google Scholar 

  9. Garcia-Portilla MP, Saiz PA, Bascaran MT, et al. Cardiovascular risk in patients with bipolar disorder. J Affect Disord. 2009;115:302-308.

    Article  PubMed  Google Scholar 

  10. Kupfer DJ. The increasing medical burden in bipolar disorder. JAMA. 2005;93:2528-2530.

    Article  Google Scholar 

  11. Daumit GL, Goff DC, Meyer JM, et al. Antipsychotic effects on estimated 10-year coronary heart disease risk in the CATIE schizophrenia study. Schizophr Res. 2008;105:175-187.

    Article  PubMed  Google Scholar 

  12. Druss BG, Rosenheck RA. Mental disorders and access to medical care in the United States. Am J Psychiatry. 1998;155:1775-1777.

    PubMed  CAS  Google Scholar 

  13. Vanable PA, Carey MP, Carey KB, Maisto SA. Smoking among psychiatric outpatients: relationship to substance use, diagnosis, and illness severity. Psychol Addict Behav. 2003;17:259-265.

    Article  PubMed  Google Scholar 

  14. Diaz FJ, James D, Botts S, Maw L, Susce MT, de Leon J. Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression. Bipolar Disord. 2009;11:154-165.

    Article  PubMed  Google Scholar 

  15. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA. 2000;284:2606-2610.

    Article  PubMed  CAS  Google Scholar 

  16. Australian Institute of Health and Welfare: Australia's health 2010 (AIHW Cat. No. AUS 122) 2010.

  17. Dodd S, Brnabic AJ, Berk L, et al. A prospective study of the impact of smoking on outcomes in bipolar and schizoaffective disorder. Compr Psychiatry. 2010;51:504-509.

    Article  PubMed  Google Scholar 

  18. Waxmonsky JA, Thomas MR, Miklowitz DJ, et al. Prevalence and correlates of tobacco use in bipolar disorder: data from the first 2000 participants in the Systematic Treatment Enhancement Program. Gen Hosp Psychiatry. 2005;27:321-328.

    Article  PubMed  Google Scholar 

  19. Berk M, Ng F, Wang WV, et al. Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania. J Affect Disord. 2008;110:126-134.

    Article  PubMed  Google Scholar 

  20. Baker A, Lubman DI, Hides L. Smoking and schizophrenia: treatment approaches within primary care. Prim Psychiatry. 2010;17:49-54.

    Google Scholar 

  21. Banham L, Gilbody S. Smoking cessation in severe mental illness: what works? Addiction. 2010;105:1176-1189.

    Article  PubMed  Google Scholar 

  22. El-Guebaly N, Cathcart J, Currie S, Brown D, Gloster S. Smoking cessation approaches for persons with mental illness or addictive disorders. Psychiatr Serv. 2002;53:1166-1170.

    Article  PubMed  Google Scholar 

  23. Morrison KN, Naegle MA. An evidence-based protocol for smoking cessation for persons with psychotic disorders. J Addict Nursing. 2010;21:79-86.

    Article  Google Scholar 

  24. Baker A, Richmond R, Haile M, et al. A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. Am J Psychiatry. 2006;163:1934-1942.

    Article  PubMed  Google Scholar 

  25. Baker A, Richmond R, Castle D, et al. Coronary heart disease risk reduction intervention among overweight smokers with a psychotic disorder: pilot trial. Aust N Z J Psychiatry. 2009;43:129-135.

    Article  PubMed  Google Scholar 

  26. Baker A, Kay-Lambkin FJ, Richmond R, et al. Study protocol: a randomised controlled trial investigating the effect of a healthy lifestyle intervention for people with severe mental disorders. BMC Public Health. 2011;11:10.

    Article  PubMed  Google Scholar 

  27. Sweeney CT, Fant RV, Fagerstrom KO, McGovern JF, Henningfield JE. Combination nicotine replacement therapy for smoking cessation: rationale, efficacy and tolerability. CNS Drugs. 2001;15:453-467.

    Article  PubMed  CAS  Google Scholar 

  28. McNeil JJ, Piccena L, Ioannides LI. Smoking cessation: recent advances. Cardiovasc Drugs Ther. 2010;24:359-367.

    Article  PubMed  CAS  Google Scholar 

  29. Campion J, Checinski K, Nurse J. Review of smoking cessation treatments for people with mental illness. APT. 2008;14:208-216.

    Google Scholar 

  30. Foulds J, Steinberg MB, Williams JM, Ziedonis DM. Developments in pharmacotherapy for tobacco dependence: past, present and future. Drug Alcohol Rev. 2006;25:59-71.

    Article  PubMed  Google Scholar 

  31. Hughes J, Lesmes GR, Hatsukami DK, et al. Are higher does of nicotine replacement more effective for smoking cessation? Nicotine Tob Res. 1999;1:169-174.

    Article  PubMed  CAS  Google Scholar 

  32. Williams JM, Foulds J. Successful tobacco dependence treatment in schizophrenia. Am J Psychiatry. 2007;164:222-227.

    Article  PubMed  Google Scholar 

  33. Williams JM, Hughes JR. Pharmacotherapy treatments for tobacco dependence among smokers with mental illness or addiction. Psychiatr Ann. 2003;22:457-466.

    Google Scholar 

  34. Els C, Kunyk D. Management of tobacco addiction in patients with mental illness. Smoking Cessation Rounds. 2008; 2–2.

  35. Siru R, Hulse GK, Tait RJ. Assessing motivation to quit smoking in people with mental illness: a review. Addiction. 2009;104:719-733.

    Article  PubMed  Google Scholar 

  36. Baker A, Richmond R, Haile M, et al. Characteristics of smokers with a psychotic disorder and implications for smoking interventions. Psychiatry Res. 2007;150:141-152.

    Article  PubMed  Google Scholar 

  37. Filia SL, Baker AL, Richmond R, et al. Health Behavior risk factors for coronary heart disease (CHD) in smokers with a psychotic disorder: baseline results. Ment Health Subst Use. 2011;4:158-171.

    Google Scholar 

  38. Fagerstrom K, Aubin HJ. Management of smoking cessation in patients with psychiatric disorders. Curr Med Res Opin. 2009;25:511-518.

    Article  PubMed  Google Scholar 

  39. Baker A, Lewin T, Reichler H, et al. Evaluation of a motivational interview for substance use within psychiatric in-patient services. Addiction. 2002;97:1329-1337.

    Article  PubMed  Google Scholar 

  40. Baker A, Bucci S, Lewin TJ, et al. Cognitive-behavioural therapy for substance use disorders in people with psychotic disorders: randomised controlled trial. Br J Psychiatry. 2006;188:439-448.

    Article  PubMed  Google Scholar 

  41. Martino S, Carroll KM, Nich C, et al. A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug-use disorders. Addiction. 2006;101:1479-1492.

    Article  PubMed  Google Scholar 

  42. Barrowclough C, Haddock G, Tarrier N, et al. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry. 2001;158:1706-1713.

    Article  PubMed  CAS  Google Scholar 

  43. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. New York: Guilford Press; 2002.

    Google Scholar 

  44. Williams JM, Zimmermann MH, Steinberg ML, et al. A comprehensive model for mental health tobacco recovery in New Jersey. Adm Policy Ment Health. 2010; doi:10.1007/s10488-010-0324-x

  45. Hughes JR. Depression during tobacco abstinence. Nicotine Tob Res. 2007;9:443-446.

    Article  PubMed  Google Scholar 

  46. Zevin S, Benowitz NL. Drug interactions with tobacco smoking. An update. Clin Pharmacokinet. 1999;36:425-438.

    Article  PubMed  CAS  Google Scholar 

  47. Osborn DPJ, Nazareth I, King MB. Physical activity, dietary habits and coronary heart disease risk factor knowledge amongst people with severe mental illness: a cross sectional comparative study in primary care. Soc Psych Psych Epid. 2007;42:787-793.

    Article  Google Scholar 

  48. McElroy SL, Kotwal R, Malhotra S, Nelson EB, Keck PE, Nemeroff CB. Are mood disorders and obesity related? A review for the mental health professional. J Clin Psychiatry. 2004;65:634-651.

    Article  PubMed  Google Scholar 

  49. Virk S, Schwartz TL, Jindal S, Nihalani N, Jones N. Psychiatric medication induced obesity: an aetiologic review. Obes Rev. 2004;5:167-170.

    Article  PubMed  CAS  Google Scholar 

  50. Torrent C, Amann B, Sanchez-Moreno F, et al. Weight gain in bipolar disorder: pharmacological treatment as a contributing factor. Acta Psych Scand. 2008;118:4-18.

    Article  CAS  Google Scholar 

  51. Fagiolini A, Kupfer DJ, Houck PR, Novick DM, Frank E. Obesity as a correlate of outcome in patients with bipolar I disorder. Am J Psychiatry. 2003;160:112-117.

    Article  PubMed  Google Scholar 

  52. Fagiolini A, Kupfer DJ, Rucci P, Scott JA, Novick DM, Frank E. Suicide attempts and ideation in patients with bipolar I disorder. J Clin Psychiatry. 2004;65:509-514.

    Article  PubMed  Google Scholar 

  53. Hyman DJ, Pavlik VN, Taylor WC, Goodrick GK, Moye L. Simultaneous vs sequential counseling for multiple behavior change. Arch Intern Med. 2007;167:1152-1158.

    Article  PubMed  Google Scholar 

  54. Spring B, Howe D, Berendsen M, et al. Behavioral intervention to promote smoking cessation and prevent weight gain: a systematic review and meta-analysis. Addiction. 2009;104:1472-1486.

    Article  PubMed  Google Scholar 

  55. Spring B, Pagoto S, Pingitore R, Doran N, Schneider K, Hedeker D. Randomized controlled trial for behavioral smoking and weight control treatment: effect of concurrent versus sequential intervention. J Consult Clin Psychol. 2004;72:785-796.

    Article  PubMed  Google Scholar 

  56. Baker AL, Kay-Lambkin FJ, Richmond R, et al. Healthy lifestyle intervention for people with severe mental disorders. Ment Health Subst Use. 2011;4:144-157.

    Google Scholar 

  57. Berlin I. Endocrine and metabolic effects of smoking cessation. Curr Med Res Opin. 2009;25:527-534.

    Article  PubMed  Google Scholar 

  58. Perkins KA. Smoking cessation in women. Special considerations. CNS Drugs. 2001;15:391-411.

    Article  PubMed  CAS  Google Scholar 

  59. Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and dependence. Clinical practice guidelines. Rockville, MD: US Department of Health and Human Service. Public Health Service; Update 2008; Accessible at: http//www.surgeongeneral.gov.tobacco

  60. Wye P, Bowman J, Wiggers J, et al. Providing nicotine dependence treatment to psychiatric inpatients: the views of Australian nurse managers. J Psychiatr Ment Health Nurs. 2010;17:319-327.

    Article  PubMed  CAS  Google Scholar 

  61. Filia SL, Shelton C, Gurvich CT, et al. Becoming a smokefree inpatient psychiatry ward: the staff perspective. Aust N Z J Psychiatry. 2008;42:A61.

    Google Scholar 

  62. McKee SA, O'Malley SS, Salovey P, Krishnan-Sarin S, Mazure CM. Perceived risks and benefits of smoking cessation: gender-specific predictors of motivation and treatment outcome. Addict Behav. 2005;30:423-435.

    Article  PubMed  Google Scholar 

  63. Filia SL, Baker AL, Richmond R, Lewin TJ, Gurvich CT, Kulkarni J. Gender differences among smokers diagnosed with psychosis. The Australasian Society for Psychiatric Research (ASPR) conference; Sydney, Australia 2010.

Download references

ACKNOWLEDGMENTS

Funding for the randomized controlled smoking cessation trial was provided by the Australian National Health and Medical Research Council (NHMRC), while GlaxoSmithKline provided NRT for the study. Thank you to Dr. Kate Hoy and Dr. Stuart Lee for support in preparation of this manuscript.

Disclosures

Ms. Sacha Filia has received funding support from Monash University. Professor Amanda Baker reports no competing interests. Associate Professor Jill Williams has received grant support from the National Institutes of Health (NIMH and NIDA) and Pfizer. She is a consultant and advisory board member for Pfizer. Professor Jayashri Kulkarni has received grant support from: Stanley Medical Research Institute, NHMRC, AstraZeneca, Mayne Pharma, Servier, Eli Lilly, Jansen-Cilag, Neurosciences Australia, Department of Human Services (Victoria); has received an honoraria as a speaker for Jansen-Cilag, Lundbeck, AstraZeneca, and Bristol Myers Squib; and is an advisory board member for Jansen-Cilag, Bristol Myer Squib, and Pfizer.

Author information

Authors and Affiliations

  1. Monash Alfred Psychiatry Research Centre (MAPrc), Monash University, Level 1, Old Baker Building, The Alfred Hospital, PO Box 315, Prahran, VIC, 3181, Australia

    Sacha L Filia BSc(Hons), PhD Candidate & Jayashri Kulkarni MBBS, MPM, FRANZCP, PhD

  2. Centre for Brain and Mental Health Research (CBMHR), University of Newcastle, Newcastle, NSW, Australia

    Amanda L Baker BA(Hons), MClinPsych, PhD

  3. Division of Addiction Psychiatry, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Jill M Williams MD

Authors
  1. Sacha L Filia BSc(Hons), PhD Candidate
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amanda L Baker BA(Hons), MClinPsych, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jayashri Kulkarni MBBS, MPM, FRANZCP, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jill M Williams MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sacha L Filia BSc(Hons), PhD Candidate.

Additional information

Implications

Practice: Multiple health behavior interventions in smokers with severe mental illness are feasible and can be effective.

Policy: A behavioral approach developed to help smokers without severe mental illness to quit and manage weight may also have applicability for people with bipolar disorder who smoke and share similar concerns about gaining weight.

Research: Further studies in bipolar disorder are required to determine if established treatments for smoking cessation are effective and feasible in this population.

About this article

Cite this article

Filia, S.L., Baker, A.L., Kulkarni, J. et al. Sequential behavioral treatment of smoking and weight control in bipolar disorder. Behav. Med. Pract. Policy Res. 2, 290–295 (2012). https://doi.org/10.1007/s13142-012-0111-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13142-012-0111-1

KEYWORDS

Search

Navigation