Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial.

Journal article

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.

Authors: Miklowitz, D; Axelson, D; Birmaher, B; George, E; Taylor, DO

• Publication status: Published
• Journal: Archives of general psychiatry
• Volume: 65
• Issue: 9
• Pages: 1053-1061
• Publication date: 2008-09-01
• DOI: 10.1001/archpsyc.65.9.1053
• EISSN: 1538-3636
• ISSN: 0003-990X
• Language: English
• Keywords: Patient Compliance; Family Health; Male; Female; Algorithms; Convalescence; Anticonvulsants; Adolescent; Antipsychotic Agents; Bipolar Disorder; Family Therapy; Recurrence; Humans