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

Abstract

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...

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