Pharmacotherapy and family-focused treatment for adolescents with bipolar I and II disorders: a 2-year randomized trial.
Title | Pharmacotherapy and family-focused treatment for adolescents with bipolar I and II disorders: a 2-year randomized trial. |
Publication Type | Journal Article |
Year of Publication | 2014 |
Authors | Miklowitz DJ, Schneck CD, George EL, Taylor DO, Sugar CA, Birmaher B, Kowatch RA, DelBello MP, Axelson DA |
Journal | Am J Psychiatry |
Volume | 171 |
Issue | 6 |
Pagination | 658-67 |
Date Published | 2014 Jun |
ISSN | 1535-7228 |
Keywords | Adolescent, Antipsychotic Agents, Bipolar Disorder, Family Therapy, Female, Humans, Male, Psychiatric Status Rating Scales, Psychotherapy, Brief, Time Factors, Treatment Outcome |
Abstract | OBJECTIVE: Previous studies have found that family-focused treatment is an effective adjunct to pharmacotherapy in stabilizing symptoms in adult bipolar disorder. The authors examined whether pharmacotherapy and family-focused treatment for adolescents with bipolar disorder was more effective than pharmacotherapy and brief psychoeducation (enhanced care) in decreasing time to recovery from a mood episode, increasing time to recurrence, and reducing symptom severity over 2 years. METHOD: A total of 145 adolescents (mean age, 15.6 years) with bipolar I or II disorder and a DSM-IV-TR manic, hypomanic, depressive, or mixed episode in the previous 3 months were randomly assigned, with family members, either to pharmacotherapy and family-focused treatment, consisting of psychoeducation (i.e., recognition and early intervention with prodromal symptoms), communication enhancement training, and problem-solving skills training, delivered in 21 sessions over 9 months; or to pharmacotherapy and three weekly sessions of enhanced care (family psychoeducation). Independent evaluators assessed participants at baseline, every 3 months during year 1, and every 6 months during year 2, using weekly ratings of mood. RESULTS: Twenty-two participants (15.2%) withdrew shortly after randomization. Time to recovery or recurrence and proportion of weeks ill did not differ between the two treatment groups. Secondary analyses revealed that participants in family-focused treatment had less severe manic symptoms during year 2 than did those in enhanced care. CONCLUSIONS: After an illness episode, intensive psychotherapy combined with best-practice pharmacotherapy does not appear to confer advantages over brief psychotherapy and pharmacotherapy in hastening recovery or delaying recurrence among adolescents with bipolar disorder. |
DOI | 10.1176/appi.ajp.2014.13081130 |
Alternate Journal | Am J Psychiatry |
PubMed ID | 24626789 |
PubMed Central ID | PMC4083000 |
Grant List | R01 MH073871 / MH / NIMH NIH HHS / United States R01 MH073871 / MH / NIMH NIH HHS / United States R01 MH093676 / MH / NIMH NIH HHS / United States R01MH073817 / MH / NIMH NIH HHS / United States R01MH074033 / MH / NIMH NIH HHS / United States R21 MH097007 / MH / NIMH NIH HHS / United States R33 MH097007 / MH / NIMH NIH HHS / United States R34MH077856 / MH / NIMH NIH HHS / United States |