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 therapy for adolescents (FFT-A) and pharmacotherapy in the 2-year course of adolescent bipolar disorder.Design and setting-Two-site outpatient randomized controlled trial with 2-year follow-up.Patients-A referred sample of 58 adolescents (14.5 ± 1.6 yrs) 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). FFT-A consisted of 21 sessions in 9 months of psychoeducation, communication training, and problem-solving skills training. EC consisted of 3 family sessions focused on relapse prevention.Main Outcome Measures-Independent "blind" evaluators assessed patients every 3-6 months over 2 years. Outcomes included time to recovery from the index episode, time to recurrence, weeks in episode/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 (HR = 1.85; 95% CI: 1.04 -3.29; P = .037). The groups did not

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 © 2008 American Medical Association. All rights reserved.Correspondence: David J. Miklowitz, PhD, Department of Psychology, Muenzinger Bldg, University of Colorado, Boulder, CO 80309-0345 (miklowitz@colorado.edu).. Author Contributions: Dr Miklowitz verifies that he had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr Dickinson was the project statistician. Additional Contributions: Adrine Biuckians, MA, Tina Goldstein, PhD, Eunice Kim, PhD, Kimberley Mullen, MA, Amy Schlonski, LCSW, and Tim Winbush, LCSW, served as study therapists; Susan Wassick, RN, Amy Mechels, MA, Chad Morris, PhD, Victoria Cosgrove, MA, and Laura Wagenknecht, MA, served as independent evaluators; and Mary Beth Hickey served as the study's data manager.Financial Disclosure: Dr Miklowitz reported receiving funding from the National Institute of Mental Health (NIMH), the National Association for Research on Schizophrenia and Depression, the Robert Sutherland Foundation, and the Danny Alberts Foundation, and book royalties from Guilford Press and John Wiley and Sons. Dr Birmaher reported receiving honoraria from Solvay Pharmacueticals and Abcomm, Inc, and book royalties from Random House, Inc. Dr Craighead reported receiving honoraria from Forest Laboratories, Eli Lilly Co, and Novadel, and book royalties from John Wiley and Sons. Previous Presentation:The results were presented in part at the annual meeting of the American Association of Child and Adolescent Psychiatry; October 24, 2007; Boston, Massachusetts. The past decade has witnessed a remarkable increase in diagnoses of bipolar disorder in children and adolescents an...

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Pediatric patients with autism spectrum disorders (ASD) and/or intellectual disabilities (ID) are at greater risk for psychiatric hospitalization compared to children with other disorders. However, general psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of this population, and there are few specialized hospital-based psychiatric care programs in the United States. This paper compares patient outcomes from a specialized psychiatric hospital program developed for pediatric patients with an ASD and/or ID to prior outcomes of this patient population in a general psychiatric program at a children's hospital. Record review data indicate improved outcomes for patients in the specialized program of reduced recidivism rates (12% versus 33%) and decreased average lengths of inpatient stay (as short as 26 days versus 45 days). Available data from a subset of patients (n = 43) in the specialized program showed a decrease in irritability and hyperactivity behaviors from admission to discharge and that 35 previously undetected ASD diagnoses were made. Results from this preliminary study support specialized psychiatric care practices with this population to positively impact their health care outcomes.