Sequential behavioral treatment of smoking and weight control in bipolar disorder

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.