January 16, 2020
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Family-focused therapy reduces mood episodes in youths at risk for bipolar disorder

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David J. Miklowitz

Children and adolescents who are at high risk for bipolar disorder achieved longer times between mood episodes after receiving family-focused therapy, according to results of a randomized clinical trial published in JAMA Psychiatry.

“If kids who are at risk for bipolar disorder are living in chaotic households with no boundaries or highly critical parents, they will do worse over time,” David J. Miklowitz, PhD, of the department of psychiatry and biobehavioral sciences at the University of California, Los Angeles, said in a press release. “Involving the parents in the child’s therapy teaches family members how to create a more protective environment so that kids can stay well for longer.”

According to Miklowitz and colleagues, youth who develop bipolar disorder during childhood and who receive delayed first treatment have higher levels of depression, less time being euthymic and poorer functioning in adulthood. Psychosocial interventions may mitigate these risks by teaching youths skills for coping with stress, achieving autonomy and developing social supports, they noted.

The researchers examined whether family-focused therapy — 12 sessions of family psychoeducation, problem-solving skills training and communication skills training across 4 months — was more effective than standard psychoeducation in delaying emergence of mood episodes and hastening recovery during the 1 to 4 years following an active period of mood symptoms. They included 127 participants aged 9 years to 17 years with major depressive disorder or unspecified bipolar disorder, active mood symptoms and at least one first- or second-degree relative with bipolar disorder 1 or 2. Of these, 61 received family-focused therapy and 66 received enhanced usual care, defined as six sessions of family and individual psychoeducation across 4 months. Approximately 60% of all participants received medications for symptoms of depression, mood instability, ADHD or anxiety, with regimens equivalent in the two therapy treatments.

The researchers followed up all participants for a median of 98 weeks and detected no differences between treatments in time to recovery from pretreatment symptoms. Those in the family-focused therapy group experienced longer intervals from recovery to next mood episode emergence, as well as from randomization to the next mood episode, than those who received enhanced care. Further, family-focused therapy resulted in longer intervals to depressive episodes. However, it did not differ from enhanced care in time to manic or hypomanic episodes, symptom trajectories or conversions to bipolar disorder.

“We don’t know yet whether bipolar disorder can be prevented,” Miklowitz said. “What we’re trying to do is to catch the illness early so that kids and teens, with the help of their families, can learn ways to reduce the severity of their symptoms and the frequency in which symptoms recur.” – by Joe Gramigna

Disclosures: Miklowitz reports support from the National Institute of Mental Health; grants from the Danny Alberts Foundation, the Attias Family Foundation, the Carl and Roberta Deutsch Foundation, the Kayne Family Foundation, AIM for Mental Health, the American Foundation for Suicide Prevention and the Max Gray Fund; and book royalties from Guilford Press and John Wiley and Sons. Please see the study for all other authors’ relevant financial disclosures.