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)

基本信息

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
项目类别：
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

项目摘要

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）：在所有精神科诊断中，双相情感障碍 (BP) 导致青春期自杀的风险最大，并且与其他负面结果相关，包括心理社会功能不良和药物滥用。此外，患有高血压的青少年的医疗费用超过了其他青少年精神疾病的医疗费用。治疗指南表明，儿科血压的最佳治疗包括药物治疗和心理治疗的结合。然而，人们对针对这一人群的有效心理治疗方法知之甚少，也没有一个明确针对自杀倾向。对患有高血压的青少年进行有效且具有成本效益的心理治疗具有巨大的潜力，可以显着降低与这种疾病相关的发病率、死亡率和费用。辩证行为疗法（DBT）是一种基于技能的心理疗法，最初是为患有边缘性人格障碍的成年人开发的。鉴于自杀倾向和心理社会功能等共同治疗目标，DBT 为患有 BP 的青少年带来了希望。本课题组关于青少年血压 DBT 的初步数据为该治疗模式的可行性和可接受性提供了强有力的支持，并表明 DBT 与自杀、情绪失调和抑郁等靶向治疗领域的改善相关，并且这些改善在青少年中更大接受 DBT 与在我们的儿童和青少年双相情感障碍服务 (CABS) 专业诊所提供的标准护理 (SOC) 心理治疗进行比较。拟议的研究旨在通过随机对照试验评估 DBT + 药物治疗与 CABS SOC 心理治疗 + 药物治疗在患有 BP 的青少年 (12-18 岁) (n=100) 中随访 2 年的疗效。主要结果领域包括自杀事件和情绪症状。我们的团队包括一位卫生服务成本效益方面的专家，使我们能够检查 DBT 的成本效益。我们的探索性目标是阐明该人群 DBT 治疗反应的调节因子和调节因子。确定预测 DBT 反应的患者因素以及 DBT 使患者受益的机制，将直接为最有可能受益的人群有计划地传播治疗（如果显示有效）提供信息。这些目标与 NIMH 战略计划直接一致，该计划优先考虑改进精神疾病治疗方法的研究；通过展示成本效益，促进循证干预措施的广泛使用；并系统地研究个性化干预的要素。此外，该项目与国家自杀预防行动联盟研究优先工作组的使命相一致：优先考虑研究中的差距，以降低自杀率和自杀未遂率，针对特别高风险群体，并朝着采用基于证据的自杀干预措施。