Early-onset bipolar disorder: A family treatment perspective
Early-onset bipolar disorder: A family treatment perspective
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DOI：
10.1017/s0954579406060603
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发表时间：
2006-09-01
影响因子：
3.3
通讯作者：
Richards, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Miklowitz, David J.;Biuckians, Adrine;Richards, Jeffrey A.
情绪障碍症状及其相关的功能障碍被认为是遗传、生物和心理脆弱性、家庭痛苦和生活压力在不同发育阶段共同、交互影响的结果。我们讨论了一个发展的精神病理学模型，该模型描述了早发性双相情感障碍患者的高家庭冲突和情绪恶化的途径。一项治疗发展研究的新数据表明，高表达情感家庭的青少年双相患者比低表达情感家庭的青少年有更多的症状病程超过2年。慢性和间歇性应激源也与青少年在接受治疗时情绪缺乏改善有关。以家庭为中心的治疗(FFT)结合药物治疗似乎可以改善成人双相情感障碍的病程。这种治疗方法最近进行了修改，以解决青少年中双相情感障碍的发育性表现。我们提供了来自FFT和药物治疗(N=20)的公开试验的数据，表明双相青少年在两年内稳定在躁狂、抑郁和父母评估的问题行为中。未来的研究应侧重于澄清早发性双相情感障碍的发展途径，以及保护性因素和预防性心理社会干预在推迟该疾病首次发作方面的作用。
Mood disorder symptoms and their associated functional impairments are hypothesized to come about as the result of the conjoint, interactive influences of genetic, biological, and psychological vulnerabilities, family distress, and life stress at different points of development. We discuss a developmental psychopathology model that delineates pathways to high family conflict and mood exacerbation among early-onset bipolar patients. New data from a treatment development study indicate that adolescent bipolar patients in high expressed emotion families have more symptomatic courses of illness over 2 years than adolescents in low expressed emotion families. Chronic and episodic stressors are also correlated with lack of mood improvement while adolescents are in treatment. Family-focused treatment (FFT) given in conjunction with pharmacotherapy appears to ameliorate the course of bipolar disorder in adults. This treatment has recently been modified to address the developmental presentation of bipolar disorder among adolescents. We present data from an open trial of FFT and pharmacotherapy (N = 20) indicating that bipolar adolescents stabilize in mania, depression, and parent-rated problem behaviors over 2 years. Future research should focus on clarifying the developmental pathways to early-onset bipolar disorder and the role of protective factors and preventative psychosocial interventions in delaying the first onset of the disorder.