AIM:To conduct a review of the telepsychiatry literature.

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

The coronavirus disease 2019 pandemic is a seminal event that is precipitating radical transformative change to our society and health care systems. Social distancing, isolation, and deployment of suppression and mitigation strategies are directly influencing the morbidity and mortality rates of the pandemic. 1 Remote communication technologies are being broadly deployed in all spheres of medicine to support these strategies while still delivering effective health care. Telepsychiatry, in the form of videoconferencing and other technologies, was uniquely positioned to push the field of psychiatry to the forefront of these efforts. Prior to the pandemic, telepsychiatry had built a strong scientific foundation and real-world evidence base, demonstrating its effectiveness across a range of psychiatric treatments, populations, and settings. 2-5 Although previously leveraged temporarily in disaster response, 6 telepsychiatry's use in the COVID-19 pandemic has been distinctive and will have long-lasting and wide-ranging effects on the field of psychiatry, including mental health care delivery and configuration and patient experience and expectations.Globally, health care systems, psychiatric organizations, and individual clinicians have been rapidly virtualizing their operations. These activities have included the extensive use of videoconferencing, either expanding or initiating direct clinician-home to patient-home services, and partially or fully virtualizing administrative operations. Implementation has occurred at a pace never experienced in telemedicine, with many large organizations fully virtualizing in a matter of days. Historically, full implementation of telepsychiatry, especially in large organizations, could take months to years. Rapid virtualization has shown that clinicians, patients, and systems can quickly adapt to telepsychiatry, although not without challenges and lessons learned. Previous barriers including regulatory constraints, system inertia, and general resistance to telepsychiatry have disappeared, at least temporarily; technical innovations abound as clinicians and organizations work to best configure telepsychiatry to current clinical needs and environments.Historically, telepsychiatry has experienced a substantial evolutionary period with the expansion of the internet and the use of other technologies and peripheral devices that are ubiquitous to consumers and based largely on commercial uses and applications. Currently, in response to the COVID-19 emergency, there has been an unprecedented revolution in the telehealth landscape with the lifting of federal and state regulatory barriers to telemedicine and telepsychiatry. Such changes include the suspension of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which placed VIEWPOINT

While DSM-IV rapid cycling was prospectively observed in only a small percentage of patients, the majority of these patients had continued recurrences at lower but clinically significant rates. This suggests that cycling is on a continuum and that prevention of recurrences may require early intervention and restricted use of antidepressants.

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...

Objective Depression and brief periods of (hypo)mania are linked to an increased risk of progression to bipolar I or II disorder (BD) in children of bipolar parents. This randomized trial examined the effects of a 4-month family-focused therapy (FFT) program on the 1-year course of mood symptoms in youth at high familial risk for BD, and explored its comparative benefits among youth in families with high vs. low expressed emotion (EE). Method Participants were 40 youth (mean 12.3 ± 2.8 years, range 9–17) with BD not otherwise specified, major depressive disorder, or cyclothymic disorder who had a first-degree relative with BD I or II and active mood symptoms (Young Mania Rating Scale [YMRS] > 11 or Child Depression Rating Scale > 29). Participants were randomly allocated to FFT–High Risk version (FFT-HR; 12 sessions of psychoeducation and training in communication and problem-solving skills) or an education control (EC; 1–2 family sessions). Results Youth in FFT-HR had more rapid recovery from their initial mood symptoms (hazard ratio = 2.69, p = .047), more weeks in remission, and a more favorable trajectory of YMRS scores over 1 year than youth in EC. The magnitude of treatment effect was greater among youth in high-EE (vs. low-EE) families. Conclusions FFT-HR may hasten and help sustain recovery from mood symptoms among youth at high risk for BD. Longer follow-up will be necessary to determine if early family intervention has downstream effects that contribute to the delay or prevention of full manic episodes in vulnerable youth. Clinical trial registration information—Early Family-Focused Treatment for Youth at Risk for Bipolar Disorder; http://www.clinicaltrials.gov/; NCT00943085.

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DisclosuresDr. Miklowitz has received research funding from the National Institute of Mental Health (NIMH), the National Association for Research on Schizophrenia and Depression (NARSAD), the Danny Alberts Foundation, the Attias Family Foundation, and the Robert L. Sutherland Foundation; and royalties from Guilford Press and John Wiley and Sons. Dr. Schneck has received funding from the Crowne Family Foundation. Dr. Cosgrove has received funding from the Lucille Packard Foundation for Children's Health, Spectrum Child Health, and the Klingenstein Third Generation Foundation. Dr. Garber has received funding from NIMH and the William T. Grant Foundation. Dr. Chang has received research funding from NIMH, NARSAD, Merck, and GlaxoSmithKline; and is a non-paid consultant for GlaxoSmithKline, Eli Lilly and Company, Bristol-Myers Squibb, and Merck. Drs. Singh, Taylor, George, Dickinson, and Ms. Howe report no biomedical financial interests or potential conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptObjective-Depression and brief periods of (hypo)mania are linked to an increased risk of progression to bipolar I or II disorder (BD) in children of bipolar parents. This randomized trial examined the effects of a 4-month family-focused therapy (FFT) program on the 1-year course of mood symptoms in youth at high familial risk for BD, and explored its comparative benefits among youth in families with high vs. low expressed emotion (EE).Method-Participants were 40 youth (mean 12.3 ± 2.8 years, range 9-17) with BD not otherwise specified, major depressive disorder, or cyclothymic disorder who had a first-degree relative with BD I or II and active mood symptoms (Young Mania Rating Scale [YMRS] > 11 or Child Depression Rating Scale > 29). Participants were randomly allocated to FFT-High Risk version (FFT-HR; 12 sessions of psychoeducation and training in communication and problem-solving skills) or an education control (EC; 1-2 family sessions).Results-Youth in FFT-HR had more rapid recovery from their initial mood symptoms (hazard ratio = 2.69, p = .047), more weeks in remission, and a more favorable trajectory of YMRS scores over 1 year than youth in EC. The magnitude of treatment effect was greater among youth in high-EE (vs. low-EE) families.Conclusions-FFT-HR may hasten and help sustain recovery from mood symptoms among youth at high risk for BD. Longer follow-up will be necessary to determine if early family intervention has downstream effects that contribute to the dela...