Dialectical Behavior Therapy (DBT) for Adolescents with Bipolar Disorder

针对双相情感障碍青少年的辩证行为疗法 (DBT)

• 批准号: 9029354
• 负责人: TINA R GOLDSTEIN
• 金额: $ 78万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-23 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9029354
• 关键词: Admission activity; Adolescence; Adolescent; Adult; Advisory Committees; Age; Behavioral; Bipolar Disorder; Borderline Personality Disorder; Child; Clinic; Clinical Research; Combination Drug Therapy; Combination Medication; Conflict (Psychology); Data; Dialectical behavior therapy; Elements; Emergency Situation; Emergency medical service; Event; Evidence based intervention; Exhibits; Expenditure; Family; Guidelines; Health; Health Care Costs; Health Services; Healthcare; Inpatients; Intervention; Legal; Mediator of activation protein; Medical; Mental Depression; Mental disorders; Mission; Modeling; Moods; Morbidity - disease rate; National Institute of Mental Health; Outcome; Patients; Personality; Pharmacotherapy; Population; Prevention Research; Provider; Psychiatric Diagnosis; Psychotherapy; Public Health; Randomized Controlled Trials; Recording of previous events; Research; Risk; Services; Severities; Strategic Planning; Substance abuse problem; Suicide; Suicide attempt; Suicide prevention; System; Targeted Research; Youth; accomplished suicide; base; childhood bipolar disorder; cost; cost effective; cost effectiveness; depressive symptoms; early onset; emotion dysregulation; follow-up; health care service; health care service utilization; high risk; ideation; improved; inpatient psychiatric treatment; medical specialties; mood symptom; mortality; personalized intervention; predicting response; primary outcome; psychosocial; skills; standard of care; suicidal; suicidal risk; suicide rate; targeted treatment; therapy development; treatment response; uptake

DESCRIPTION (provided by applicant): Of all psychiatric diagnoses, bipolar disorder (BP) imparts the greatest risk for completed suicide in adolescence, and is associated with other negative outcomes including poor psychosocial functioning and substance abuse. Furthermore, healthcare costs for adolescents with BP exceed those for other adolescent psychiatric conditions. Treatment guidelines indicate optimal management of pediatric BP includes a combination of pharmacotherapy and psychotherapy. Yet, little is known about effective psychotherapy approaches for this population, and none expressly target suicidality. An efficacious, cost-effective psychotherapy for adolescents with BP has great potential to decrease the substantial morbidity, mortality and costs associated with this illness. Dialectical Behavior Therapy (DBT) is a skills-based psychotherapy originally developed for adults with borderline personality disorder. DBT holds promise for adolescents with BP given shared treatment targets including suicidality and psychosocial functioning. Our group's preliminary data on DBT for adolescents with BP provide strong support for the feasibility and acceptability of the treatment model, and indicate DBT is associated with improvement in targeted treatment domains including suicidality, emotional dysregulation, and depression, and these improvements are greater among adolescents receiving DBT as compared with standard of care (SOC) psychotherapy delivered at our Child and Adolescent Bipolar Services (CABS) specialty clinic. The proposed study aims to evaluate in a randomized controlled trial the efficacy of DBT + pharmacotherapy as compared with CABS SOC psychotherapy + pharmacotherapy over 2 year follow- up among adolescents (age 12-18) with BP (n=100). Primary outcome domains include suicidal events and mood symptoms. Our team includes an expert in health services cost effectiveness, enabling us to examine the cost effectiveness of DBT. Our exploratory aim is to elucidate moderators and mediators of DBT treatment response in this population. Identification of patient factors that predict response to DBT, as well as mechanisms by which DBT benefits patients, will directly inform the planful dissemination of the treatment (if shown to be effective) for those most likely to benefit. These aims are in direct accord with the NIMH Strategic Plan to prioritize research on improved treatments for mental illness; facilitate widespread use of evidence- based interventions by demonstrating cost effectiveness; and systematically study elements of personalized intervention. Furthermore, this project aligns with the mission of the National Action Alliance for Suicide Prevention Research Prioritization Task Force: to prioritize gaps in the research that will reduce the rate of suicide and suicide attempts, to target particularly high-risk groups, and to move toward uptake of evidence-based interventions for suicidality.

描述（由申请人提供）：在所有精神病诊断中，双相情感障碍（BP）赋予青春期完成自杀的最大风险，并且与其他负面结果有关，包括不良的心理社会功能和药物滥用。此外，BP的青少年的医疗保健费用超过了其他青少年精神病疾病。治疗指南表明，小儿BP的最佳管理包括药物治疗和心理疗法的结合。然而，对于该人群的有效心理治疗方法知之甚少，也没有明确针对自杀。 BP的青少年有效，具有成本效益的心理治疗具有巨大的潜力，可以降低与这种疾病相关的大量发病率，死亡率和成本。辩证行为疗法（DBT）是一种基于技能的心理治疗，最初是为人格障碍的成年人开发的。 DBT对具有BP的青少年有希望，包括自杀和社会心理功能，包括共同的治疗目标。 BP青少年对DBT的初步数据为治疗模型的可行性和可接受性提供了强有力的支持，并且表明DBT与针对性治疗领域的改善有关，包括自杀性，情绪失调和抑郁症，以及这些改善的抑郁症和这些改进的dbt everctions in Chard of Carection（我们的Chambt of Care of Care）（我们的Cham in Carape of Cham）（我们的Cham in Carape）（我们的Cham）均具有更大的影响。诊所。拟议的研究旨在在一项随机对照试验中评估DBT +药物治疗的疗效与CABS SOC心理治疗 +药物治疗相比，在青少年（12-18岁）中，BP（n = 100）在2年内进行了随访。主要结果领域包括自杀事件和情绪症状。我们的团队包括卫生服务成本效益的专家，使我们能够检查DBT的成本效益。我们的探索目的是阐明该人群中DBT治疗反应的主持人和介体。鉴定预测对DBT反应的患者因素以及DBT受益于患者的机制，将直接为最有可能受益的人的治疗计划（如果证明是有效的，是有效的）。这些目标与NIMH的战略计划直接相一致，以优先考虑改进精神疾病治疗方法的研究；通过证明成本效益来促进广泛使用基于证据的干预措施；并系统地研究个性化干预的要素。此外，该项目符合国家预防自杀行动联盟研究优先级委员会的使命：在研究中优先考虑差距，这将降低自杀和自杀企图的速度，以针对特别高风险的群体，并朝着基于证据的干预措施迈向自杀。