What lifestyle interventions can I suggest to a patient with bipolar disorder to help manage their condition?

For patients with bipolar disorder, several lifestyle interventions can be recommended to assist in managing their condition and preventing relapse:

• Routine and Self-Monitoring: Encourage compliance with treatment and establishing a regular morning routine ¹. Patients should structure their day with some activity and social contact ¹. Advise self-monitoring of symptoms, including identifying triggers and early warning signs, and developing coping strategies ¹.
• Sleep Management: Emphasise maintaining an adequate amount of sleep ¹. Patients should avoid, if possible, shift work, night flying, flying across time zones, or routinely working excessively long hours ¹.
• Substance Avoidance: Advise avoiding alcohol and drug misuse ¹. Patients who smoke should be advised to stop or cut down, as nicotine is a stimulant ¹. Additionally, recommend avoiding caffeinated drinks such as tea, coffee, or cola ¹.
• Physical Health and Diet: Encourage discussions about diet and level of physical activity, and monitor the patient's weight and waist circumference ¹. Identify and manage conditions such as hypertension, abnormal lipid levels, obesity, or diabetes, or those at risk of these conditions, at the earliest opportunity ¹,².
• Psychological Interventions: Psychological interventions, often offered by secondary care, can provide information about bipolar disorder, help patients consider the impact of thoughts and behaviour on moods and relapse, and include self-monitoring of mood, thoughts, and behaviour ². These interventions also address relapse risk, distress, and how to improve functioning, and help develop plans for relapse management and staying well ². Problem-solving to address communication patterns and managing functional difficulties may also be included ².
• Environmental and Social Support: During episodes of mania or hypomania, advise patients to access calming environments and reduced stimulation ². Patients should be advised not to make important decisions until they have recovered from mania or hypomania ². Encourage them to maintain their relationships with their carers if possible ². Consider offering assistance with education, financial, and employment problems that may arise from the behaviour associated with bipolar disorder ².