Early Intervention for Symptomatic Youth at Risk for Bipolar Disorder: A Randomized Trial of Family-Focused Therapy

Abstract

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.

Diagnostic Precursors to Bipolar Disorder in Offspring of Parents With Bipolar Disorder: A Longitudinal Study

“…For instance, a recent study demonstrated benefits from a family-focused approach for symptomatic youth who had a first degree relative with bipolar disorder. (32) Given the clear prognostic significance of subthreshold (hypo)mania in youth at familial risk for bipolar disorder, we need additional treatment research for these youth. As both major depressive episodes and disruptive behavior disorders also indicate risk of future bipolarity, they are indications for close clinical monitoring in high-risk offspring.…”

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

“…Youth who received FFT had more rapid recovery from their initial mood symptoms, experienced more weeks in remission, and had lower YMRS scores over 1 year compared to youth who received enhanced care. 185 In a second study, youth with depression and transient manic symptoms were 4 times less likely to convert to BPSD at 12-month follow-up if they received multi-family psychoeducational psychotherapy plus treatment as usual (TAU) compared to the group who received only TAU. 186 …”

Treatment of Psychiatric Symptoms Among Offspring of Parents With Bipolar Disorder

“…For example, families with Bipolar Disorder tend to have low cohesion, organization and expressiveness, but high conflict; and chaos in the family may be associated with prefrontal-subcortical disconnectivity [25]. Interventions aimed at improving communication and reducing family stress are beneficial to these high-risk youth [26] and may improve prefrontal regulation of subcortically driven mood dysregulation [27]. In their 16-year prospective cohort study, Duffy and colleagues [28] studied 233 adolescents and their parents who completed clinical assessments prospectively over a decade [19].…”