Early psychosocial intervention for youth at risk for bipolar I or II disorder: a one-year treatment development trial

Abstract

Objectives-Previous studies have identified behavioral phenotypes that predispose genetically vulnerable youth to a later onset of bipolar I or II disorder, but few studies have examined whether early psychosocial intervention can reduce risk of syndromal conversion. In a one-year open trial, we tested a version of family-focused treatment adapted for youth at high risk for bipolar disorder (FFT-HR).Methods-A referred sample of 13 children (mean 13.4 ± 2.69 years; 4 boys, 9 girls) who had a parent with bipolar I or II disorder participated at one of two outpatient specialty clinics. Youth met DSM-IV criteria for major depressive disorder (n = 8), cyclothymic disorder (n = 1), or bipolar disorder not otherwise specified (n = 4), with active mood symptoms in the past month. Participants were offered FFT-HR (12 sessions in four months) with their parents, plus psychotropic medications as needed. Independent evaluators assessed depressive symptoms, hypomanic symptoms, and global functioning at baseline and then every four months for one year, with retrospective severity and impairment ratings made for each week of the follow-up interval.Results-Families were mostly adherent to the treatment protocol (85% retention), and therapists administered the FFT-HR manual with high levels of fidelity. Youth showed significant improvements in depression, hypomania, and psychosocial functioning scores on the Adolescent Longitudinal Interval Follow-up Evaluation. They also showed significant improvements in Young Mania Rating Scale and Children's Depression Rating Scale scores.Conclusions-FFT-HR is a promising intervention for youth at high risk for BD. Larger-scale randomized trials that follow youth into young adulthood will be necessary to determine whether early psychosocial intervention can reduce the probability of developing bipolar I or II disorder among genetically vulnerable youth. Between 50-66% of adult patients with bipolar disorder (BD) report onset of their disease prior to 18 years, and 15-28% report onset before age 13 (1). BD in childhood or adolescence exhibits a more severe, protracted, and continuously cycling course compared to adult-onset BD, often with mixed episodes, longer episode durations, psychosis, and multiple comorbidities (2). Many of these features also characterize prodromal forms of the illness, which can be identified in childhood or early adolescence (3,4).Several research groups have identified the phenotype that may be most likely to predispose youth to the later development of bipolar illness. Birmaher et al. (3) found that youth (mean age 7-17 years) who met research criteria for BD not otherwise specified (NOS)-operationalized by multiple short periods of mania that do not meet the DSM-IV episode duration thresholds or symptom count criteria-are at substantially elevated risk for 'converting' to bipolar I disorder (BD-I) or bipolar II disorder (BD-II). When stratifying by family history of BD-I or BD-II, the risk of conversion in youth presenting with the BD-NOS phenotype was 51...

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…In a one-year open trial, a modified FFT was associated with improved depression, hypomania, and psychosocial functioning scores in youth who were thought to be at high risk for developing BD (241). Preliminary findings suggest that child and family-focused CBT (242), dialectical behavior therapy (DBT) (243), and IPSRT (244) may be promising in the management of BD in this patient population.…”

Transtorno bipolar em crianças e adolescentes: critérios para diagnóstico e revisão de intervenções psicossociais

“…Apesar disso, os estudos demonstraram eficácia em alguns aspectos, tais como, a redução dos sintomas do TB (e.g., Miklowitz et al, 2008;Fristad et al, 2009;Fristad, 2006;Fristad et al, 2002;Miklowitz et al, 2004;Miklowitz et al, 2011), comportamentos mais adequados dos pais frente ao TB de seus filhos (e.g., Fristad et al, 2003;Fristad, 2006); melhora do relacionamento familiar (e.g., Fristad, 2006;Fristad et al, 2002); ganho de experiência, aumento do conhecimento dos pais em relação à doença e aumento do apoio familiar e social (e.g., Fristad et al, 2003;Fristad et al, 2002). Estes resultados se mantiveram após o follow-up.…”

Früherkennung und Frühintervention bei bipolaren Störungen

“…Hier sollten wir aufgrund der noch wenigen Validitätsdaten mit risikoarmen Therapiemöglichkeiten beginnen und können von den Erfahrungen der Frühintervention bei Psychosen profitieren (bei denen sich im Sinne eines "Stagings" ein Trend hin zu risikoärme-ren Interventionsformen zeigt) [9]. Da die Evidenz psychotherapeutischer Interventionen bei Risikopersonen für die Entwicklung bipolarer Störungen sehr spär-lich ist (aktuell liegt nur eine publizierte Studie zur familienfokussierten Therapie aus der Gruppe um D. Miklowitz vor [35]), indirekte Evidenz jedoch vermuten lässt, dass eine kognitive Verhaltenstherapie (angepasst an die Bedürfnisse der Risikopopulation) wirksam sein könnte, haben die Autoren zu dieser Frage eine randomisierte DFG-geförderte klinische Studie konzipiert, die aktuell mit den Netzwerkpartnern umgesetzt wird (EarlyCBT, http://www.germanctr.de).…”