Family-Focused Treatment for Bipolar Adolescents

以家庭为中心的双相情感障碍青少年治疗

基本信息

批准号：
8036434
负责人：
DAVID Jay MIKLOWITZ
金额：
$ 8.66万
依托单位：
UNIVERSITY OF COLORADO
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-03-01 至 2011-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8036434
关键词：
Acute Adherence Adolescence Adolescent Adult Affective Antipsychotic Agents Anxiety Bipolar Disorder Caregivers Caring Child Child Psychiatry Childhood Clinical Colorado Combined Modality Therapy Communication Comorbidity Consumption Disease Distress Education Evaluation Expressed Emotion Family Family Sizes Family psychotherapy Frequencies Future Health Resources Hostility Impairment Intake Intervention Lead Life Manic Measures Mediating Mediator of activation protein Mental Depression Mental Health Mental Health Services Modeling Monitor Mood Disorders Mood stabilizers Moods Outcome Outcome Assessment Parents Patients Pharmaceutical Preparations Pharmacotherapy Practice Guidelines Prevention Problem Solving Protocols documentation Psychopathology Psychopharmacology Psychotic Disorders Public Health Quality of life Randomized Recovery Recurrence Relapse Relative (related person)Resistance Risk Risk Factors Sampling Severities Site Sleep Sleep Wake Cycle Social Functioning Stress Structure Suicide Suicide attempt Symptoms Testing Time Training Translating Treatment Cost Treatment Efficacy base community setting depressive symptoms efficacy testing follow-up functional disability functional improvement functional outcomes improved innovation knowledge base medication compliance prognostic psychoeducation psychosocial randomized trial response service utilization skills training therapy development treatment effect treatment trial

项目摘要

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）：即使积极使用情绪稳定剂和抗精神病药物进行治疗，双相情感障碍 (BP) 青少年的复发率、自杀企图、功能障碍和服务利用率也很高。尽管其公共卫生风险相当大，但目前还没有针对患有 BP 的青少年的基于经验的、针对疾病的心理社会干预措施。这项为期 5 年的研究将在一项 3 中心随机试验（科罗拉多大学 [协调中心；D. Miklowitz，PI]，匹兹堡大学 [D. Axelson，PI] 和 Cinn Childrens [R. FFT 是一项为期 9 个月的干预措施，包括心理教育、沟通培训和解决问题，在科罗拉多州和匹兹堡进行的一项为期 1 年的治疗开发研究中，FFT 使青少年的临床症状显着改善。我们将 150 名最近发生过急性情感发作的 BP I 或 BP II 青少年（50 名/中心）随机分组：(1) FFT 加药物治疗或 (2) 简短心理教育（强化护理，或 EC）加药物治疗。随机化将根据现场、双相 I 型和疾病极性进行分层。药物治疗将遵循一套由药物治疗委员会密切监控的最佳实践指南。结果评估包括 K-SADS 和两年内每 3-6 个月对父母和青少年进行一次的纵向间隔随访评估。生存和混合效应回归模型将检验以下假设：与 EC 和药物治疗相比，FFT 和药物治疗可加速康复、延迟复发、减少躁狂和抑郁症状、增强功能和生活质量，并减少辅助服务利用率。二次分析将检验关于治疗调节因素的两个假设（家族表达的情绪、基线症状严重程度）和两个中介假设：治疗相关的家庭功能改善预测抑郁症状的稳定，而药物依从性和睡眠/觉醒规律的改善预测抑郁症状的稳定的躁狂症状。最后，我们将比较治疗的相对成本。研究完成后，我们将获得一个知识库，以帮助开发青少年血压治疗的最佳实践模型，该模型将以家庭为中心的问题解决与精神药理学相结合。

项目成果

期刊论文数量（27）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Mood instability as a predictor of clinical and functional outcomes in adolescents with bipolar I and bipolar II disorder.

情绪不稳定是 I 型双相情感障碍和 II 型双相情感障碍青少年临床和功能结果的预测因子。

DOI：
发表时间：
2018-08-15
期刊：
影响因子：
6.6
作者：
O'Donnell, Lisa A;Ellis, Alissa J;Van de Loo, Margaret M;Stange, Jonathan P;Axelson, David A;Kowatch, Robert A;Schneck, Christopher D;Miklowitz, David J
通讯作者：
Miklowitz, David J

Classifying Mood Symptom Trajectories in Adolescents With Bipolar Disorder.

对双相情感障碍青少年的情绪症状轨迹进行分类。

DOI：
发表时间：
2020
期刊：
影响因子：
13.3
作者：
Weintraub, Marc J;Schneck, Christopher D;Axelson, David A;Birmaher, Boris;Kowatch, Robert A;Miklowitz, David J
通讯作者：
Miklowitz, David J

Effects of Family-Focused Therapy vs Enhanced Usual Care for Symptomatic Youths at High Risk for Bipolar Disorder: A Randomized Clinical Trial.

以家庭为中心的治疗与加强日常护理对双相情感障碍高风险有症状青少年的影响：一项随机临床试验。

DOI：
发表时间：
2020
期刊：
影响因子：
25.8
作者：
Miklowitz, David J;Schneck, Christopher D;Walshaw, Patricia D;Singh, Manpreet K;Sullivan, Aimee E;Suddath, Robert L;Forgey Borlik, Marcy;Sugar, Catherine A;Chang, Kiki D
通讯作者：
Chang, Kiki D

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

以家庭为中心的双相情感障碍治疗：30 年研究反思。