Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial

Arch Gen Psychiatry. 2008 Sep;65(9):1053-61. doi: 10.1001/archpsyc.65.9.1053.

Abstract

Context: Family interventions have been found to hasten episode recovery and delay recurrences among adults with bipolar disorder.

Objective: To examine the benefits of family-focused treatment for adolescents (FFT-A) and pharmacotherapy in the 2-year course of adolescent bipolar disorder.

Design: Two-site outpatient randomized controlled trial with 2-year follow-up.

Patients: A referred sample of 58 adolescents (mean [SD] age, 14.5 [1.6] years) with bipolar I (n = 38), II (n = 6), or not otherwise specified disorder (n = 14) with a mood episode in the prior 3 months.

Interventions: Patients were randomly assigned to FFT-A and protocol pharmacotherapy (n = 30) or enhanced care (EC) and protocol pharmacotherapy (n = 28). The FFT-A consisted of 21 sessions in 9 months of psychoeducation, communication training, and problem-solving skills training. The EC consisted of 3 family sessions focused on relapse prevention.

Main outcome measures: Independent "blind" evaluators assessed patients every 3 to 6 months for 2 years. Outcomes included time to recovery from the index episode, time to recurrence, weeks in episode or remission, and mood symptom severity scores.

Results: Analyses were by intent to treat. Rates of 2-year study completion did not differ across the FFT-A (60.0%) and EC conditions (64.3%). Although there were no group differences in rates of recovery from the index episode, patients in FFT-A recovered from their baseline depressive symptoms faster than patients in EC (hazard ratio, 1.85; 95% confidence interval, 1.04-3.29; P = .04). The groups did not differ in time to recurrence of depression or mania, but patients in FFT-A spent fewer weeks in depressive episodes and had a more favorable trajectory of depression symptoms for 2 years.

Conclusions: Family-focused therapy is effective in combination with pharmacotherapy in stabilizing bipolar depressive symptoms among adolescents. To establish full recovery, FFT-A may need to be supplemented with systematic care interventions effective for mania symptoms.

Trial registration: ClinicalTrials.gov NCT00571402.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Algorithms
  • Anticonvulsants / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Bipolar Disorder / therapy*
  • Convalescence
  • Family Health
  • Family Therapy / methods*
  • Female
  • Humans
  • Male
  • Patient Compliance / statistics & numerical data
  • Recurrence

Substances

  • Anticonvulsants
  • Antipsychotic Agents

Associated data

  • ClinicalTrials.gov/NCT00571402