Will Meecham, MD
Point Of View
Our brains and bodies are one. The brain directs the activities of the body, while the body provides the environment the brain needs to work properly. Neither can function without the other. As a result, the health of our bodies must not be ignored when we work to improve our mental wellness. There are many ways in which emotional wellness or distress influence somatic health, and vice versa.
For instance, an occasional case of what looks like psychiatric illness is discovered to be due to thyroid dysfunction. The early stages of dementia sometimes manifest as behavioral disturbances. It is important to detect such conditions in order to ensure proper diagnosis and avoid inappropriate treatments.
Chronic pain can exacerbate depression, as well as be worsened by it. Similarly, it is well known that emotional stress and heart disease are interrelated. Immune competence appears to be influenced by emotional states. These bidirectional influences between bodily and mental health are probably the rule rather than the exception, though the strength of the associations vary widely.
At the same time, the qualities of nutrition, rest, and conditioning all influence mental well-being. Although frequently overstated, the "sugar rush" and subsequent "crash" are widely known results of a particular kind of improper nutrition. Alterations in the sleep-wake cycle occur commonly when moods fluctuate in bipolar conditions, while shift work and jet lag have been observed to set off mood crises.
Finally, medications for psychiatric disorders may have substantial medical consequences. Weight gain, neurologic symptoms, and sexual dysfunction are common side effects. At the same time, some drugs for medical conditions alter moods, cause anxiety, disrupt the sleep-wake cycle, etc.
Success in the Bipolar Advantage program therefore requires the participation of medical practitioners. Depending on the client's situation and preference, medical workup and management may be the responsibility of his or her existing primary care provider. Alternatively, members of the Advantage medical staff can take on this role.
Integration With Team
A medical perspective ensures that focus on mental wellness does not become too narrow, and that the health of the body, the brain's companion, is kept in mind. The practitioner brings a biological perspective to the table. In many cases, an initial evaluation provides a "clean bill of health." Afterwards, the client's Advantage team can direct the journey toward Results Worth Striving For assured that there are no hidden medical problems which might affect or be affected by its recommendations.
Other times, ongoing or newly discovered medical conditions need to be managed so that the person's comfort level, physical functioning, and longevity are maximized. In these cases, the rest of the team is kept appraised of changes in medication, physical capabilities, recommended nutrition, or needs for any specific therapy. If psychiatric pharmaceuticals are part of the client's program, the medical practitioner works closely with the psychiatrist to ensure that drugs are chosen that carry the least risk to the body's health, are compatible with any other medications the client takes, and that somatic side effects are anticipated and dealt with appropriately.
Assessment Process
The medical assessment is tailored to the client, but emphasizes identification of illnesses known to be common in those with psychiatric disorders. In particular, attention is paid to detecting medical conditions that might cause symptoms of mental illness. In addition, any limitations on exercise capability are identified, so that the regimen of vigorous physical activity that is part of the Advantage Program can be tailored to the client's strengths and limitations.
The medical provider obtains a detailed medical history, keeping in mind the presence of a psychiatric condition. A thorough history documents prior medical disorders, and sometimes unearths symptoms suggestive of illnesses that might explain or result from psychiatric problems, or that necessitate adjustments to the Advantage Program. A thorough physical examination identifies problems that need further assessment. Comprehensive laboratory studies are ordered to identify metabolic, endocrine, hematologic, infectious, inflammatory, neoplastic, and other diseases. An EKG is obtained to help rule out occult cardiac disorders. Diagnostic imaging is arranged as indicated. Most clients benefit from a brain MRI to eliminate concern that structural brain abnormalities might be causing their symptoms.
Additional studies may be required, depending on the client's age and prior history, the results of the physical examination, and initial diagnostic investigations. Some clients require an EEG to further evaluate neurologic and/or psychiatric symptoms. In other cases, sleep studies or exercise stress tests may be indicated. Obviously, the list of possible diagnostic studies is long and depends on findings in each case. The goal, however, is always to maximize the client's general health and his or her ability to safely achieve Results Worth Striving For.
Goal Setting
Medical goals in the Advantage Program are similar to those for the general public. However, people with mental illness often have increased sensitivity to bodily imbalances. Therefore, it is of paramount importance that the Advantage client works toward a healthful regimen of nutrition, exercise, and sleep hygiene. Although other team members usually direct the client as lifestyle goals are formulated, the medical provider oversees the plan. He or she also follows the client over time to be sure the lifestyle changes are well tolerated by the body.
The client's medical history at intake and any newly discovered physical disorders dictate whether the medical provider suggests specific additional goals. Whenever possible, attempts are made to bring the body into a state of optimal health with a minimum of medical intervention. For this reason, and in order to further the client's mental wellness, a healthy lifestyle is one of the pillars of the Advantage Program.
Treatment
Other team members help the client achieve the desired changes to diet, exercise, substance use, sleep, and so on. However, the medical provider maintains oversight in order to ensure safety and optimal results with regards to bodily health. Where necessary, the provider prescribes medications and other treatments for physical conditions, whether ongoing or newly discovered in the course of the Advantage medical workup.
Specific behavioral improvements are frequently advised. Smoking cessation aids will be prescribed as needed. Medical assistance with substance abuse recovery is provided when necessary. Dietary changes may be indicated to reduce weight, improve cholesterol profiles, decrease fasting glucose levels, or lower blood pressure. Hopefully, such changes will forestall the need for medication to manage hypercholesterolemia, hypertension, or diabetes.
When needed, the patient may be referred for outside management of complex medical conditions. However, conservative measures are preferred when possible, and the medical provider works with the rest of the team to help optimize the client's bodily health, comfort, and longevity. The medical perspective ensures that Results Worth Striving For include improvement in bodily health as well as mental well-being.
Comments are closed.