Expressed Emotion Moderates the Effects of Family-Focused Treatment for Bipolar Adolescents

Miklowitz, David J.; Axelson, David; George, Elizabeth; Taylor, Dawn O.; Schneck, Christopher D.; Sullivan, Aimee E.; Dickinson, L. Miriam; Birmaher, Boris

doi:10.1097/chi.0b013e3181a0ab9d

Cited by 107 publications

(97 citation statements)

References 32 publications

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“…Using the conventional EE classification criteria (above), 17 families (48.6%) were rated high-EE, a rate almost identical to the rate previously observed in families of adolescents with BD I or II (46.2%). 16 Family EE status was unrelated to whether the family had two parents (n = 23) or a single parent (n = 17) (χ 2 [1] =.27, p = .60), or whether there were two biological parents (n = 21) or a single biological parent living in the home (n = 19; χ 2 [1] =.03, P = .86).…”

Section: Psychiatric Diagnoses and Expressed Emotion Among First-degrmentioning

confidence: 99%

“…15 Further, in two trials, adolescent or adult patients in high EE families had a greater magnitude of treatment response compared to patients in low EE families. 16,17 This randomized trial examined whether a brief (4-month) early family intervention (FFTHigh Risk protocol [FFT-HR]) was effective in stabilizing mood symptoms among youth who were at high-risk for BD. In a previous open trial of FFT-HR, offspring of parents with BD I or II who were diagnosed with MDD or BD-NOS showed significant improvements in depression and hypomania scores and psychosocial functioning over 1 year.…”

Section: Introductionmentioning

confidence: 99%

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

Miklowitz

Schneck

Singh

et al. 2015

FOC

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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...

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Section: Psychiatric Diagnoses and Expressed Emotion Among First-degrmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Miklowitz

Schneck

Singh

et al. 2015

FOC

Self Cite

View full text Add to dashboard Cite

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“…For example, a combination of features now allows detecting the prodrome of schizophrenia with more than 80% accuracy in adolescents who have not yet become psychotic (Cannon et al, 2008). Further along in the prevention spectrum, characteristics of the family environment moderate how adolescents with early-stage bipolar disorder respond to psychosocial interventions combined with medication; here a family-focused approach appears to be most beneficial-and perhaps essential-for families showing high "expressed emotion" (criticism, hostility, and emotional overinvolvement) in relation to the patient (Miklowitz et al, 2009).…”

Section: Prevention For Whom?mentioning

confidence: 99%

“…For example, there is evidence that baseline levels of maladaptive cognitions hypothesized to maintain depressive symptoms serve to moderate the success of cognitive-behavior therapies relative to control conditions (Hollon et al, 2005) and that theory-relevant aspects of a patient's trauma history are associated with better response to a variant of cognitive behavior therapy than to antidepressants (Nemeroff et al, 2003). Similarly, looking beyond the patient, the quality of family or couple communication appears to moderate the success of family-and couple-focused treatments (Miklowitz et al, 2009;Shoham, Rohrbaugh, Stickle, & Jacob, 1998).…”

Section: Which Treatments For Whom?mentioning

confidence: 99%

Rebooting Psychotherapy Research and Practice to Reduce the Burden of Mental Illness

Kazdin

Blase

2011

Perspect Psychol Sci

1,128

839

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Psychological interventions to treat mental health issues have developed remarkably in the past few decades. Yet this progress often neglects a central goal-namely, to reduce the burden of mental illness and related conditions. The need for psychological services is enormous, and only a small proportion of individuals in need actually receive treatment. Individual psychotherapy, the dominant model of treatment delivery, is not likely to be able to meet this need. Despite advances, mental health professionals are not likely to reduce the prevalence, incidence, and burden of mental illness without a major shift in intervention research and clinical practice. A portfolio of models of delivery will be needed. We illustrate various models of delivery to convey opportunities provided by technology, special settings and nontraditional service providers, self-help interventions, and the media.

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“…This situation may further complicate the situation of children with depression, for certain interpersonal characteristics such as high levels of "expressed emotion" (described as criticism, hostility or emotional over involvement of caregivers toward a family member suffering from a psychiatric illness) can negatively influence the treatment and prognosis of several psychiatric disorders, including unipolar depression and Bipolar Disorder [48,[256][257][258].…”

Section: Prognosismentioning

confidence: 99%

Childhood Depression As Emerging Public Health Problem: A Systematic Review

Pimentel¹,

Júnior²,

Júnior³

et al. 2015

Int Arch Med

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As an important problem of public health, the childhood depression deserves special attention, in which the serious and long term consequences of the disease weigh to the childhood development. Taking this in consideration, the present study was based in the following research question: which practical contribution the actual scientific literature about childhood depression has to offer to clinicians and researchers? The aim of the present study was to evaluate the actual evidence concerning the different aspects (etiology/risk factors, diagnosis, treatment, prognostic and prevention) of childhood depression, with the purpose to systematize such evidences and to contribute with the knowledge about the problem. In way to reach this aim, it was performed a systematic review of articles about childhood depression, in the period from January first of 2010 to January 16 of 2014, in the databases PubMED, MEDLINE and SciELO. In the research, the following terms were used: "depression" (MeSH), "child" (MeSH) and "childhood depression" (Keyword). Of the 860 found studies, 76 met the eligibility criteria. The found studies covered a wide variety of aspects related to childhood depression, as diagnosis, treatment, prevention and prognostic. The actual scientific literature about the childhood depression converges to, directly or not, highlight the negative impacts of the depression disorders to the life quality of the children. Unfortunately, the found studies show that the childhood depression is a disorder that develops most commonly in a poverty and vulnerability scenery, where the individual and familiar necessities concerning the childhood depression are not always taken in consideration. In this context, this review demonstrates that the depression started in

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Expressed Emotion Moderates the Effects of Family-Focused Treatment for Bipolar Adolescents

Cited by 107 publications

References 32 publications

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

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

Rebooting Psychotherapy Research and Practice to Reduce the Burden of Mental Illness

Childhood Depression As Emerging Public Health Problem: A Systematic Review

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