Family-Focused Treatment for Adolescents With Bipolar Disorder

Miklowitz, David J.; Axelson, David; Birmaher, Boris; George, Elizabeth; Taylor, Dawn O.; Schneck, Christopher D.; Beresford, Carol; Dickinson, L. Miriam; Craighead, W. Edward; Brent, David A.

doi:10.1001/archpsyc.65.9.1053

Cited by 218 publications

(172 citation statements)

References 50 publications

Supporting

Mentioning

160

Contrasting

Unclassified

Order By: Relevance

“…51,107,133 There were no studies on psychosis. Most (31/71) of the studies concerned interventions that could be classified as treatments (see Chapter 1, Intervention levels), [48][49][50][51][52]55,65,66,70,71,74,77,78,81,[83][84][85][86]91,[94][95][96][97][98][101][102][103][104]106,111,112,[121][122][123][124][125][126][127][129][130][131]133,135,139 with the remainder focusing equally on indicated (n = 11), 53,58,59,…”

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

“…Sixteen of the interventions were individual child/young person or individual family interventions; 48,65,[69][70][71]74,[83][84][85][86][87][95][96][97][98]111,[121][122][123][124][125][126][127][129][130][131]133,135 the remainder were group interventions or group interventions with occasional individual sessions. Of those studies where a delivery location was given, most of the interventions (33/71) took place in a school setting, 39,[45][46][47]49,50,53,[57][58][59][60]62,63,65,73,82,[90][91][92][93][94]…”

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Pryjmachuk

Elvey

Kirk

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

BackgroundThe mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health.ObjectivesTo identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision.DesignTwo inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study.SettingGlobal (systematic reviews); England and Wales (mapping exercise and case study).Participants (case study)Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites.Main outcome measures (meta-analysis)A measure of CYP’s mental health symptomatology.Data sources (literature reviews)MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC).Review methodsTitles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review.ResultsSixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support.ConclusionsMental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes.Future workFuture work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness.Study registrationPROSPERO number (for the effectiveness review) CRD42012001981.FundingThe NIHR Health Services and Delivery Research programme.

show abstract

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Pryjmachuk

Elvey

Kirk

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

show abstract

“…89 Two randomised controlled trials including symptomatic patients with bipolar I and II found that, in the 1-2 years after a manic, mixed, or depressive episode, patients with bipolar disorder who received familyfocused therapy and pharma cotherapy had 30-35% lower rates of relapse and rehospitalisation and less severe symptoms than did patients in case manage ment 28 or equally intensive individual treatment. 63 Two randomised controlled trials in paediatric populations-one in adolescents (aged 12-18 years) with bipolar disorder 64 and one in children and adolescents (aged 9-17 years) with depression or hypomania with a first degree relative with bipolar disorder 65 -found that children and adolescents who received familyfocused therapy and pharmacotherapy recovered more rapidly from depressive episodes (HR 0·37-0·54) than did children and adolescents in brief psychoeducation and pharmacotherapy.…”

Section: Family-focused Therapymentioning

confidence: 99%

The Treatment of Bipolar Disorder

Möller¹,

Nasrallah²

2017

Oxford Medicine Online

View full text Add to dashboard Cite

We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics. Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs. The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity. We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients. To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation.

show abstract

“…Expressed Emotion is an scale for the extent of the family and caregivers emotional attitudes to patient's psychiatric disorder. When talking of high EE, it is meant to be lots of critical comments, hostility-arising situations, or showing emotional over-involvement (like over protection, exaggerated emotional responses, or inordinate self-sacrifice) (Miklowitz, 2008b;Morris et al, 2007). Numerous trials have reported intense relationship between EE and poor outcome in schizophrenic patients, mood bipolar and other psychiatric disorders.…”

Section: Psychoeducation With the Familymentioning

confidence: 99%