CREST.BD Physical Health & Bipolar Disorder Slides

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CREST.BDBipolar Wellness Center Webinars
Connect. Learn. Engage.

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Bipolar Wellness Center Webinars
Connect. Learn. Engage.CREST.BD
Physical

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Connect. Learn. Engage.CREST.BDCREST.BD
Physical
Featuring: Dr. Colin Depp
CREST.BD Member,
Associate Professor of Psychiatry
University of California,
San Diego and
Associate Director,
Research Education and
Training Division, San Diego
Clinical Translational
Science Institute

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Webinar focus
Physical health
• Exercise
• Diet and nutrition
• Substance misuse
• Sexual health
Why physical health is important to your QoL
Physical health and BD
How you can take action

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Why physical health is important to your QoL
Your mind and body are connected
Taking good care of physical health is a gateway to
protecting mental health

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Sylvia, L.G., Friedman, E.S., Kocsis, J. et al. (2013). Association of exercise with QoL and mood symptoms in a
comparative effectiveness study of BD. Journal of Affective Disorders, 151: 722-727.
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De Almeida, K.M., Moreira, C.L., Lafer, B. (2012). Metabolic syndrome and BD: what should psychiatrists know?
CNS Neuroscience and Therapeutics, 18: 160–166.
Regular physical activity is particularly important for people
with BD, as it can be associated with additional physical health
challenges
• e.g., people with BD have a higher risk of cardiovascular
disease1
• BD medications can have side-effects that contribute to
‘metabolic syndrome’2
Exercise and BD

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Regular physical exercise improves:
• weight and cardiovascular health
• mental health, especially depressed mood3
Exercise and BD
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Harris, A.H.,Cronkite,R.,Moos,R. (2006). Physical activity, exercise coping, and depression in a 10 year cohort study of
depressed patients. Journal of Affective Disorders, 93: 79–85.

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Some nutrients may work with
regular medication treatment
to produce better health in
people with BD
• e.g., omega-3 fatty acids
may help symptoms of BD
• Omega-3 fatty acids may
boost how your brain
develops and works4
Diet/nutrition and BD
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Sylvia, L.G., Peters, A.T., Deckersbach, T. et al. (2013). Nutrient-based therapies for BD: a systematic review.
Psychotherapy and Psychosomatics, 82: 10-19.

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Substance use and BD
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Heffner, J.L., Strawn, J.R., DelBello, M.P., Strakowski, S.M., Anthenelli, R.M. (2011). The Co-occurrence of Cigarette
Smoking and BD: Phenomenology and Treatment Considerations. Bipolar Disorders, 13(0): 439–453.
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Salloum, I.M., Thase, M.E. (2000). Impact of substance abuse on the course and treatment of BD. Bipolar Disorders,
2: 269–280.
People with BD are:
• 3x more likely to drink too much alcohol
• 7x more likely to struggle with substance misuse
• 2-3x more likely to smoke cigarettes5
Combination of BD and substance misuse can lead to
greatly reduced QoL and health6
Substance use and mood symptoms closely
connected5

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Little research on optimal way to treat someone dealing
with BD and substance misuse (‘dual diagnosis’)
Mood stabilizing medications appear to work well even
when substance misuse is occurring
Psychological treatments (for example, CBT) for dual
diagnosis may improve depressed mood and possibly
substance misuse7,8
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Weiss, R.D. (2004). Treating patients with BD and substance dependence: lessons learned. Journal of Substance Abuse
Treatment, 27: 307-312.
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Schmitz, J.M., Averill, P.M., Sayre, S.L. et al. (2002). Cognitive-behavioral treatment of BD and substance abuse: a
preliminary randomized study. Addiction Disorders Treatment, 1: 17-24.

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“High risk” substance use:
• Use of alcohol or other substances in a way that will
have negative effects over the long-term and
increase severity of symptoms

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Sexual health and BD
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Dell’Osso, L., Carmassi, C., Carlini, M., et al. (2009). Sexual dysfunctions and suicidality in patients with BD and
unipolar depression. Journal of Sexual Medicine, 6: 3063–3070.
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Mazza, M., Harnic, D., Catalano, V., et al. (2010). Sexual behavior in women with BD. Journal of Affective Disorders,
131: 364-367.
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McCandless, F., Sladen, C. (2003). Sexual health and women with BD. Journal of Advanced Nursing, 44: 42-48.
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Bossini, L., Fagiolini, A., Valdagno, M. et al. (2007). Sexual disorders in subjects treated for mood and anxiety diseases.
Journal of Clinical Psychopharmacology, 27: 310-312.
People with conditions like BD can experience
specific issues around sexuality9
:
• sexual interest may be increased during mania10
• increased tendency to high risk sexual behavior11
• sexual desire often reduced during depression
• antidepressant medications can have reduced
libido as a side-effect12

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Limited research about optimal ways to increase sexual safety
during mania
Educational and psychological treatments may be of benefit13
:
• increased knowledge of sexual risks
• greater use of condoms
• increase ability to stand firm when refusing risky sexual
contact
• increased planning to protect safety in risky situations
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Kaltenhaler, E., Pandor, A., Wong, R. (2014). The effectiveness of sexual health interventions for people with severe
mental illness: a systematic review. Health Technology Assessment, 18 (1): 5.
Sexual health and BD

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How you can take action: Exercise
Find activities you enjoy
Make exercise rewarding
Set realistic goals
• During a manic or hypomanic phase, people with BD are
likely to set exercise goals that are too high and hard to
keep (e.g., “work out for two hours every day”)
• During depressive phases, set lower goals (e.g., “walk
to refrigerator for snack”)
Establish exercise routines
Address negative thinking patterns around exercise

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How you can take action: Diet/nutrition
Learn about the food guide
Track daily food intake with a diet diary
Set goals that are specific and achievable
Explain your goals to a trusted support person
Problem-solve around obstacles to maintaining a healthy diet
Discuss possible side-effects with your healthcare provider
See your doctor regularly for routine screening or monitoring of
metabolic risk factors

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How you can take action: Substance use
Many communities have programs for
people dealing with substance use problems,
including:
• drug and alcohol counselors
• detoxification facilities
• residential treatment centers
• support groups like Alcoholics Anonymous

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How you can take action: Smoking
To help quit smoking, there
are a range of potential
medications and behavioural
treatments (e.g., CBT)5
• Little research looking at
the effectiveness of smoking
cessation interventions in
BD specifically
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Heffner, J.L., Strawn, J.R., DelBello, M.P., Strakowski, S.M., Anthenelli, R.M. (2011). The Co-occurrence of Cigarette
Smoking and BD: Phenomenology and Treatment Considerations. Bipolar Disorders, 13(0): 439–453.

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How you can take action: Sexual health
Protect your sexual safety
• Look at the risks of disinhibited sexual behaviour
• Speak openly with a therapist or trusted friend about a
history of risky sexuality during hypomania or mania
• Make a plan for risky situations (e.g., bring a friend to look
out for you, always carry condoms)
• Discuss any medication side-effects with your healthcare
provider
• Talk with your intimate partner(s) about sexual problems/
concerns

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Tools and Resources

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Resources
Food and Mood
This website, developed by the
Depression and Bipolar Support
Alliance, gives sound advice regarding
a balanced diet. It stresses the
importance of tracking the effect
of diet changes on your mood and
getting medical advice before trying
nutritional supplements or dramatic
changes in diet.
http://www.dbsalliance.org/pdfs/
foodmoode2.pdfmentalhealth2015.
pdf

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Mayo Clinic: Do all bipolar medications cause weight gain?
This website provides a summary of current knowledge about the
relationship between BD medications and weight gain. It’s produced by the
Mayo Clinic, a highly trusted source of health knowledge.
http://www.mayoclinic.com/health/bipolar-medications-and-weight-gain/
AN02062
Resources

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Resources
Positive Coping with Health Conditions
This step-by-step self-care guide explains a series of “positive coping” skills,
based on research, that will help you to make positive changes in exercise and
diet. One section: ‘Applying the Positive Coping Skills’ (page 96), focuses on
improving physical QoL.
www.carmha.ca/pchc/

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Resources
Canadian Physical Activity
Guidelines - Canadian
Sedentary Behaviour Guidelines
This booklet offers the dos and don’ts
for physical activities across all age
ranges. It includes real life examples
of physical activity schedules and
blank logs you can use to record daily
activities throughout the week.
http://www.csep.ca/CMFiles/
Guidelines/CSEP_Guidelines_
Handbook.pdf

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Resources
Self-help strategies for cutting
down or stopping substance
abuse: a guide
This is a free downloadable guide
for managing risky substance use,
produced by the World Health
Organization.
http://whqlibdoc.who.int/
publications/2010/9789241599405_
eng.pdf?ua=1

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Resources
Healthy Place: Sexual Health and Bipolar Disorder
Natasha Tracy discusses hypersexuality and the effects of
depression and medication on sexual drive and activity for
individuals with BD.
http://www.healthyplace.com/blogs/breakingbipolar/2011/11/sexual-health-
and-bipolar-disorder/

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Resources
Everyday Health Food and Fitness Journal
Free online tracker for meals, calorie counter and fitness journal.
http://www.everydayhealth.com/calorie-counter/

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For more information and resources,
visit our Bipolar Wellness Center at:
http://www.bdwellness.com/
To assess your quality of life,
visit our QoL tool at:
http://www.bdqol.com/

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Acknowledgments

CREST.BD Physical Health & Bipolar Disorder Slides

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CREST.BD Physical Health & Bipolar Disorder Slides