Family-Focused Treatment for Bipolar Adolescents

以家庭为中心的双相情感障碍青少年治疗

• 批准号: 7038900
• 负责人: Robert Anthony Kowatch
• 金额: $ 25万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7038900
• 关键词: adolescence (12-20); behavioral /social science research tag; bipolar depression; clinical research; clinical trials; combination therapy; cooperative study; emotions; family structure /dynamics; family therapy; human subject; human therapy evaluation; interview; longitudinal human study; mental disorder chemotherapy; mental disorder diagnosis; mental health education; problem solving; quality of life; questionnaires; sleep; therapy compliance

DESCRIPTION (provided by applicant): Adolescents with bipolar disorder (BP) have high rates of recurrence, suicide attempts, functional impairment, and service utilization even when aggressively treated with mood stabilizers and antipsychotics. Despite its considerable public health risk, there are no empirically-based, disorder-specific psychosocial interventions for adolescents with BP. This 5-year study will test the efficacy of a promising new intervention for BP adolescents, family-focused treatment (FFT), as adjunct to carefully controlled pharmacotherapy in a 3-site randomized trial (U. of Colorado [coordinating site; D. Miklowitz, PI], U. of Pittsburgh [D. Axelson, PI], and Cinn. Childrens [R. Kowatch, PI]). FFT, a 9-month intervention consisting of psychoeducation, communication training, and problem-solving, led to significant clinical improvements among adolescents in a 1-year treatment development study at Colorado and Pittsburgh. We will randomize 150 BP I or BP II adolescents (50/site) with a recent acute affective episode to: (1) FFT plus pharmacotherapy or (2) brief psychoeducation (enhanced care, or EC) plus pharmacotherapy. Randomization will stratify on site, bipolar I, and illness polarity. Pharmacotherapy will follow a set of best practice guidelines as closely monitored by a pharmacotherapy committee. Outcome assessments include the K-SADS and the Longitudinal Interval Follow-up Evaluation given to parents and adolescents every 3-6 months over 2 years. Survival and mixed effects regression models will test the hypotheses that FFT and pharmacotherapy hasten recovery, delay recurrences, reduce manic and depressive symptoms, enhance functioning and quality of life, and reduce ancillary service utilization when compared to EC and pharmacotherapy. Secondary analyses will test two hypotheses concerning treatment moderators (familial expressed emotion, baseline symptom severity) and two mediational hypotheses: treatment-associated improvements in family functioning predict the stabilization of depressive symptoms, whereas improvements in medication adherence and sleep/wake regularity predict the stabilization of manic symptoms. Finally, we will compare the relative costs of treatments. At the study's completion, we will have obtained a knowledge base to help develop a best practice model of treatment for BP adolescents that integrates family-focused problem-solving with psychopharmacology.

描述（由申请人提供）：即使用情绪稳定剂和抗精神病药进行积极治疗，躁郁症的青少年（BP）也具有较高的复发率，自杀尝试，功能障碍和服务利用率。尽管公共卫生的风险很大，但对于BP的青少年来说，没有基于经验的，特定的心理社会心理干预措施。 This 5-year study will test the efficacy of a promising new intervention for BP adolescents, family-focused treatment (FFT), as adjunct to carefully controlled pharmacotherapy in a 3-site randomized trial (U. of Colorado [coordinating site; D. Miklowitz, PI], U. of Pittsburgh [D. Axelson, PI], and Cinn. Childrens [R. Kowatch, PI]). FFT是一项由心理教育，沟通培训和解决问题的9个月干预措施，在科罗拉多州和匹兹堡的一项治疗开发研究中，青少年的临床改善显着改善。我们将在最近的急性情感发作中随机对150个BP I或BP II青少年（50/站点）进行随机，为：（1）FFT加药物治疗或（2）简短的心理教育（增强的护理或EC）加药物治疗。随机化将在现场，双极I和疾病极性上分层。药物治疗将遵循由药物治疗委员会密切监测的一系列最佳实践指南。结果评估包括K-SADS和在2年内每3-6个月对父母和青少年进行的纵向间隔随访评估。生存和混合作用回归模型将检验FFT和药物治疗的假设加速恢复，延迟复发，减轻躁狂和抑郁症状，增强功能和生活质量，并减少与EC和药物治疗相比的辅助服务利用。次要分析将检验有关治疗主持人的两个假设（家族表达的情绪，基线症状严重程度）和两个中介假设：与治疗相关的家庭功能的改善预示了抑郁症状的稳定性，而药物的依从性和睡眠/尾流的稳定性可以预测躁狂症状的稳定性。最后，我们将比较治疗的相对成本。在研究完成后，我们将获得一个知识库，以帮助开发为BP青少年的最佳治疗模型，该模型将以家庭为中心的问题与心理药理学相结合。