Family-focused treatment for adolescents with bipolar disorder - Results of a 2-year randomized trial
Family-focused treatment for adolescents with bipolar disorder - Results of a 2-year randomized trial
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DOI：
10.1001/archpsyc.65.9.1053
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发表时间：
2008-09-01
影响因子：
--
通讯作者：
Brent, David A.
中科院分区：
文献类型：
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作者：
Miklowitz, David J.;Axelson, David A.;Brent, David A.
内容：家庭干预可以加速双相情感障碍成年患者的发作恢复和延迟复发。目的：研究青少年家庭治疗（FFT-A）和药物治疗在青少年双相情感障碍2年病程中的益处。设计：2年随访的两点门诊随机对照试验。患者：58名青少年样本（平均[SD]年龄，14.5 [1.6]岁）患有双相I型（n = 38）、II型（n = 6）或在前3个月内有情绪发作的未另外指明的障碍（n = 14）。患者被随机分配到FFT-A和方案药物治疗组（n=30）或加强护理（EC）和方案药物治疗组（n = 28）。FFT-A包括9个月的心理教育，沟通培训和解决问题技能培训的21个课程。EC包括3个家庭会议侧重于复发prevention.Main结果measurements：独立的“盲”评价者评估患者每3至6个月为2年。结果包括从指数发作恢复的时间，复发的时间，发作或缓解的周数，和情绪症状严重程度scores.Results：分析的意图treat. Rates 2年的研究完成没有不同的FFT-A（60.0%）和EC条件（64.3%）。尽管从指数发作中恢复的比率没有组间差异，但FFT-A组患者从基线抑郁症状中恢复的速度快于EC组患者（风险比，1.85; 95%置信区间，1.04-3.29; P=.04）。两组在抑郁或躁狂复发的时间上没有差异，但患者在FFT-A抑郁发作的时间更短，抑郁症状的轨迹更有利2 years.Conclusions：以家庭为中心的治疗与药物治疗相结合是有效的，在青少年中稳定双相抑郁症状。为了建立完全康复，FFT-A可能需要辅以对躁狂症状有效的系统性护理干预。
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.