Family-focused treatment for adolescents with bipolar disorder - Results of a 2-year randomized trial

• Type of Material: Article
• Authors: David J. Miklowitz, University of Colorado, Boulder; David A. Axelson, University of Pittsburgh; Boris Birmaher, University of Pittsburgh; Elizabeth L. George, University of Colorado, Boulder; Dawn O. Taylor, University of Colorado, Boulder; Christopher D. Schneck, University of Colorado, Boulder; Carol A. Beresford, University of Colorado, Boulder; L. Miriam Dickinson, University of Colorado, Boulder; W Edward Craighead, Emory University; David A. Brent, University of Pittsburgh
• Language: English
• Date: 2008-09-01
• Publisher: American Medical Association (AMA)
• Publication Version: Final Published Version
• Copyright Statement: ©2008 American Medical Association. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1001/archpsyc.65.9.1053
• Title of Journal or Parent Work: Archives of General Psychiatry
• ISSN: 0003-990X
• Volume: 65
• Issue: 9
• Start Page: 1053
• End Page: 1061
• Grant/Funding Information: This study was funded by National Institute of Mental Health (NIMH) grants R21-MH62555 and R01-MH073871; a Distinguished Investigator Award from the National Alliance for Research on Schizophrenia and Depression; and a Faculty Fellowship from the University of Colorado’s Council on Research and Creative Work (Dr Miklowitz); and NIMH Center Grant No. MH066371 (Dr Brent).
• Keywords: SCHIZOPHRENIA; Life Sciences & Biomedicine; SPECTRUM DISORDERS; TREATMENT ENHANCEMENT PROGRAM; DEPRESSION; COGNITIVE-BEHAVIOR THERAPY; SCHEDULE; SCHOOL-AGE-CHILDREN; EARLY-ONSET; Science & Technology; CARE; Psychiatry; MODELS
• Research Categories: Health Sciences, Mental Health; Psychology, Developmental

Abstract

Context: Family interventions have been found to hasten episode recovery and delay recurrences among adults with bipolar disorder. Objective: To examine the benefits of family-focused treatment for adolescents (FFT-A) and pharmacotherapy in the 2-year course of adolescent bipolar disorder. Design: Two-site outpatient randomized controlled trial with 2-year follow-up. Patients: A referred sample of 58 adolescents (mean [SD] age, 14.5 [1.6] years) with bipolar I (n=38), II (n=6), or not otherwise specified disorder (n= 14) with a mood episode in the prior 3 months. Interventions: Patients were randomly assigned to FFT-A and protocol pharmacotherapy (n = 30) or enhanced care (EC) and protocol pharmacotherapy (n= 28). The FFT-A consisted of 21 sessions in 9 months of psychoeducation, communication training, and problem-solving skills training. The EC consisted of 3 family sessions focused on relapse prevention. Main Outcome Measures: Independent "blind" evaluators assessed patients every 3 to 6 months for 2 years. Outcomes included time to recovery from the index episode, time to recurrence, weeks in episode or remission, and mood symptom severity scores. Results: Analyses were by intent to treat. Rates of 2-year study completion did not differ across the FFT-A (60.0%) and EC conditions (64.3%). Although there were no group differences in rates of recovery from the index episode, patients in FFT-A recovered from their baseline depressive symptoms faster than patients in EC (hazard ratio, 1.85; 95% confidence interval, 1.04-3.29; P=.04). The groups did not differ in time to recurrence of depression or mania, but patients in FFT-A spent fewer weeks in depressive episodes and had a more favorable trajectory of depression symptoms for 2 years. Conclusions: Family-focused therapy is effective in combination with pharmacotherapy in stabilizing bipolar depressive symptoms among adolescents. To establish full recovery, FFT-A may need to be supplemented with systematic care interventions effective for mania symptoms.