Family‐Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research

Miklowitz, David J.; Chung, Bowen

doi:10.1111/famp.12237

Cited by 188 publications

(109 citation statements)

References 56 publications

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“…Given that the original creation of FFT targeted factors related to depression, it may have specific antidepressant activity, which is also suggested by reduced depression relapse in maintenance studies. For relapse prevention, four significant RCTs of varying sizes have been conducted, delivered to a mixed audience of young adults and adolescents 95. In these studies, FFT demonstrated efficacy in reducing recurrence of new episodes of depression, but not mania.…”

Section: Foundations Of Managementmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Foundations Of Managementmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…Bipolar disorder typically first occurs in late adolescence or early adulthood and its course, even when treated with mood‐stabilizing medication, is significantly affected by stressful life events and family circumstances on the one hand, and family support on the other. The high frequency of relapses among young people with bipolar disorder, and the observation that relapse may be associated with high levels of parental expressed emotion, provides the rationale for the development of relapse prevention interventions (Miklowitz and Chung, ). Psychoeducational family therapy aims to prevent relapses by reducing family stress (including parental expressed emotion) and enhancing family support for youngsters with bipolar disorder who are concurrently taking mood‐stabilizing medication (Miklowitz, ).…”

Section: Emotional Problemsmentioning

confidence: 99%

Family therapy and systemic interventions for child‐focused problems: the current evidence base

Carr

2018

Journal of Family Therapy

208

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This review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis.

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“…Four randomized trials have found that FFT and pharmacotherapy are more effective than brief psychoeducation or individual supportive therapy and pharmacotherapy in reducing symptom severity and delaying recurrences among bipolar adults (Miklowitz and Chung, 2016). The empirical record of FFT-A is less certain in adolescents with BD, with one study showing significant reductions in depressive symptoms among adolescents who received FFT-A compared to EC (Miklowitz et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Enhancing quality of life among adolescents with bipolar disorder: A randomized trial of two psychosocial interventions

O’Donnell

Axelson

Kowatch

et al. 2017

Journal of Affective Disorders

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Background Adolescents with bipolar disorder (BD) report lower quality of life (QoL) than adolescents with other psychiatric disorders. This study compared the efficacy of family-focused therapy for adolescents (FFT-A) plus pharmacotherapy to brief psychoeducation (enhanced care, or EC) plus pharmacotherapy on self-rated QoL in adolescents with BD over 2 years. Methods Participants were 141 adolescents (mean age: 15.6 ± 1.4yr) with BD I or II who had a mood episode in the previous 3 months. Adolescents and parents were randomly assigned to (1) FFT-A, given in 21 sessions in 9 months of psychoeducation, communication enhancement training, and problem-solving skills training, or (2) EC, given in 3 family psychoeducation sessions. Study psychiatrists provided patient participants with protocol-based pharmacotherapy for the duration of the study. QoL was assessed with The KINDLR Questionnaire (Ravens-Sieberer and Bullinger, 1998) during active treatment (baseline to 9 months) and during a post-treatment follow-up (9–24 months). Results The two treatment groups did not differ in overall QoL scores over 24 months. However, adolescents in FFT-A had greater improvements in quality of family relationships and physical well-being than participants in EC. For quality of friendships, the trajectory during active treatment favored EC, whereas the trajectory during post-treatment favored FFT-A. Limitations We were unable to standardize medication use or adherence over time. Quality of life was based on self-report rather than on observable functioning. Conclusions A short course of family psychoeducation and skills training may enhance relational functioning and health in adolescents with BD. The effects of different psychosocial interventions on peer relationships deserves further study.

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Family‐Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research

Cited by 188 publications

References 56 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Family therapy and systemic interventions for child‐focused problems: the current evidence base

Enhancing quality of life among adolescents with bipolar disorder: A randomized trial of two psychosocial interventions

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