Sequential behavioral treatment of smoking and weight control in bipolar disorder

People with severe mental illnesses like schizophrenia and bipolar disorder live significantly shorter lives than people in the general population and most commonly die of cardiovascular disease. Cardiovascular disease 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 bipolar disorder 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.