Family-focused treatment for adolescents with bipolar disorder

Abstract

Background: Research has begun to elucidate the optimal pharmacological treatments for pediatric-onset bipolar patients, but few studies have examined the role of psychosocial interventions as adjuncts to pharmacotherapy in maintenance treatment. This article describes an adjunctive family-focused psychoeducational treatment for bipolar adolescents (FFT-A). The adult version of FFT has been shown to be effective in forestalling relapses in two randomized clinical trials involving bipolar adults.

Methods: FFT-A is administered to adolescents who have had an exacerbation of manic, depressed, or mixed symptoms within the last 3 months. It is given in 21 outpatient sessions of psychoeducation, communication enhancement training, and problem solving skills training. We describe modifications to the adult FFT model to address the developmental issues and unique clinical presentations of pediatric-onset patients.

Results: An open treatment trial involving 20 bipolar adolescents (11 boys, 9 girls; mean age 14.8+/-1.6) found that the combination of FFT-A and mood stabilizing medications was associated with improvements in depression symptoms, mania symptoms, and behavior problems over 1 year.

Limitations: These early results are based on a small-scale open trial.

Conclusions: Results from an ongoing randomized controlled trial will clarify whether combining FFT-A with pharmacotherapy improves the 2-year course of adolescent bipolar disorder. If the results are positive, then a structured manual-based psychosocial approach will be available for clinicians who treat adolescent bipolar patients in the community.

Figures

Figure 1

CONSORT diagram. FFT-A indicates family-focused therapy for adolescents; EC, enhanced care.

Figure 2

Time to recovery from depressive symptoms at study intake (N=58; mean (SD), 12.4 (17.1) weeks). After accounting for baseline depression severity, site, and sex, a Cox proportional hazards model indicated that patients receiving family-focused treatment for adolescents (FFT-A, n=30) and medication recovered from their baseline depressive symptoms faster than patients in enhanced care (EC, n=28) and medication (χ12=4.36; P=.04; hazard ratio, 1.85; 95% confidence interval, 1.04-3.29).

Figure 3

Longitudinal trajectory of Psychiatric Status Ratings (PSR) from the Adolescent Longitudinal Interval Follow-up Evaluation (N=58). Family-focused treatment for adolescents (FFT-A) was associated with a more favorable trajectory of PSR depression scores than enhanced care (EC) (treatment × time interaction, linear effect, P=.002; quadratic effect, P=.03; difference in −2 log-likelihood2=14.0, P<.001).