Pharmacotherapy and family-focused treatment for adolescents with bipolar I and II disorders: a 2-year randomized trial

Abstract

Objective: Previous studies have found that family-focused treatment is an effective adjunct to pharmacotherapy in stabilizing symptoms in adult bipolar disorder. The authors examined whether pharmacotherapy and family-focused treatment for adolescents with bipolar disorder was more effective than pharmacotherapy and brief psychoeducation (enhanced care) in decreasing time to recovery from a mood episode, increasing time to recurrence, and reducing symptom severity over 2 years.

Method: A total of 145 adolescents (mean age, 15.6 years) with bipolar I or II disorder and a DSM-IV-TR manic, hypomanic, depressive, or mixed episode in the previous 3 months were randomly assigned, with family members, either to pharmacotherapy and family-focused treatment, consisting of psychoeducation (i.e., recognition and early intervention with prodromal symptoms), communication enhancement training, and problem-solving skills training, delivered in 21 sessions over 9 months; or to pharmacotherapy and three weekly sessions of enhanced care (family psychoeducation). Independent evaluators assessed participants at baseline, every 3 months during year 1, and every 6 months during year 2, using weekly ratings of mood.

Results: Twenty-two participants (15.2%) withdrew shortly after randomization. Time to recovery or recurrence and proportion of weeks ill did not differ between the two treatment groups. Secondary analyses revealed that participants in family-focused treatment had less severe manic symptoms during year 2 than did those in enhanced care.

Conclusions: After an illness episode, intensive psychotherapy combined with best-practice pharmacotherapy does not appear to confer advantages over brief psychotherapy and pharmacotherapy in hastening recovery or delaying recurrence among adolescents with bipolar disorder.

Trial registration: ClinicalTrials.gov NCT00332098.

Figures

FIGURE 1

CONSORT Flow Diagram for a 2-Year Randomized Trial in Adolescents With Bipolar I or II Disorder Receiving Pharmacotherapy With Either Family-Focused Treatment or Enhanced Care

FIGURE 2

Mania/Hypomania Severity Scores Across Time in Adolescents With Bipolar I or II Disorder Receiving Pharmacotherapy With Either Family-Focused Treatment or Enhanced Carea a Weekly Psychiatric Status Rating Scale mania scores were obtained from the Adolescent Longitudinal Interval Follow-Up Evaluation and averaged across 3-month intervals. Family-focused treatment for adolescents (N=72) was associated with lower mean mania/ hypomania severity scores than enhanced care (N=73) during year 2 (treatment-by-time interaction, F=1.98, df=8, 742, p=0.046). Means are adjusted for prerandomization Mania Rating Scale scores from the Schedule for Affective Disorders and Schizophrenia for School-Age Children, for study site, and for living situation (with two biological parents or not).