John has not been doing well. He used to be optimistic about all challenges and, although he had ups and downs, he managed to overcome these shifts in mood and maintain a focus on achieving his life goals.
For the last year and a half he seems to be having difficulty focusing on those goals. And he seems discouraged, particularly about his overall health.
He is an older man, but his health is quite good. There is no change in objective measures of his health. He can do all the things that he used to be able to do, but he has not been exercising as much.
He feels his physical health has become fragile.
I have been trying to make sense of this shift, and also trying to figure out how to get him back on track.
Poor Health Predicts Bipolar Outcomes
Along comes an interesting article that explores how perceived physical health influences long term outcome in people with bipolar.
The authors looked at the STEP-BD data (STEP-BD is the largest long term study of bipolar patients ever conducted) and focused on perceived physical health and its relationship to future mental health. They found a very strong correlation between the two. And, as noted below, they found that what mattered was not ability to do things (a more “objective” measure of health) but rather the subjective sense of being health.
“We found that participants’ general perceptions of their physical health and bodily experiences, like pain, were associated with concurrent experiences of depression and quality of life, but how they viewed their actual ability to do specific activities (e.g., dressing, climbing stairs, carrying groceries) were not associated with concurrent mental health outcomes. General views on one’s health status further predicted course of illness at 12 and 24 month follow-ups, such that individuals presenting in the study with more negative views of their physical wellbeing tended to have more severe mood symptoms and worse functioning across the two years of observation. These data suggest that addressing broad attitudes or thoughts about physical health are important in treating individuals with bipolar disorder as subjective perceptions seem to impact course of illness.
Results also showed that one’s perceived physical health and experience of physical pain are associated with manic symptoms, both concurrently and 12 months later. This again seems to support the importance of cognitive re-structuring patient perceptions or fears about their physical health, as well as considering adjunct pain treatment for bipolar disorder.
What to do about this finding, which is not that surprising after all (except in its implication that it is perceived health more than objective health measures that predicts outcome).
The authors suggest that their finding argues for a program of addressing perceived poor physical health.
“These data suggest that addressing broad attitudes or thoughts about physical health is important in treating individuals with bipolar disorder as subjective perceptions seem to impact course of illness,” Dr. Bernstein and her colleagues wrote. Introducing stress management or relaxation training into treatments for bipolar disorder could help reduce patients’ sensations of pain and their consequences for course of illness, particularly mania and hypomania, the investigators said. Psychotherapy also could play a beneficial role for such patients “in targeting and modifying the way they think about their health.”
In addition to using meditation and mindfulness, I found myself thinking about the importance of having a sense of control over one’s life. And when things seem out of control, paying attention to what we can control rather than what we can’t. (We can’t stop ourselves from aging, for example, but we can influence how we age, and how we adapt to the changes of aging).
For more information
Patient perceptions of physical health and bipolar symptoms: The intersection of mental and physical health. Emily E. Bernstein, Dustin J. Rabideau, Margaret E. Gigler, Andrew A. Nierenberg, Thilo Deckersbach, Louisa G. Sylvia. Journal of Affective Disorders 189 (2016) 203–206