Early Family Intervention for Youth at Risk for Bipolar Disorder: Psychosocial and Neural Mediators of Outcome.
Early Family Intervention for Youth at Risk for Bipolar Disorder: Psychosocial and Neural Mediators of Outcome.
复制标题
DOI：
10.2174/1570159x21666230111120817
复制
发表时间：
2023
影响因子：
5.3
通讯作者：
中科院分区：
文献类型：
--
作者：
双相情感障碍（BD）的损害神经发育过程表明在疾病的开始阶段对青年进行早期干预的重要性。我们报告了一项针对BD高危青年（FFT-HR）的以家庭为中心的治疗的3个地点的随机试验结果，并探讨了心理社会和神经影像学变量作为治疗效果的介质。患有重度抑郁症或其他特定BD、活跃情绪症状和BD家族史的高危青年（<18岁）被随机分配至4个月的FFT-HR（心理教育、沟通和解决问题技能培训）或4个月的增强护理心理教育。由研究精神科医生提供辅助药物治疗。在符合条件的参与者接受心理社会治疗之前和之后进行神经影像学扫描。在1-4年内，独立评估人员每4-6个月对参与者进行一次症状结果采访。在中位数为98周的127名青年（平均13.2 ± 2.6岁）中，与加强护理相比，FFT-HR与新情绪发作前的更长间隔和更低的自杀意念水平相关。减少感知的家庭冲突介导的影响，心理社会干预的情绪症状的过程。在34名接受治疗前/后fMRI扫描的参与者中，与加强护理的年轻人相比，FFT-HR的年轻人（a）腹外侧PFC和前部默认模式网络之间的静息状态连接更强，（B）背外侧和内侧PFC在情绪处理和解决问题任务中的活动增加。FFT-HR可能会延迟有BD家族易感性的症状性青年的新情绪发作。假定的治疗机制包括暗示改善情绪调节的神经适应。双相情感障碍风险青年的早期干预; https：//clinicaltrials.gov/; NCT 01483391。
The impairing neurodevelopmental course of bipolar disorder (BD) suggests the importance of early intervention for youth in the beginning phases of the illness. We report the results of a 3-site randomized trial of family-focused therapy for youth at high-risk (FFT-HR) for BD, and explore psychosocial and neuroimaging variables as mediators of treatment effects. High-risk youth (<18 years) with major depressive disorder or other specified BD, active mood symptoms, and a family history of BD were randomly assigned to 4 months of FFT-HR (psychoeducation, communication and problem-solving skills training) or 4 months of enhanced care psychoeducation. Adjunctive pharmacotherapy was provided by study psychiatrists. Neuroimaging scans were conducted before and after psychosocial treatments in eligible participants. Independent evaluators interviewed participants every 4-6 months over 1-4 years regarding symptomatic outcomes. Among 127 youth (mean 13.2 ± 2.6 years) over a median of 98 weeks, FFT-HR was associated with longer intervals prior to new mood episodes and lower levels of suicidal ideation than enhanced care. Reductions in perceived family conflict mediated the effects of psychosocial interventions on the course of mood symptoms. Among 34 participants with pre-/post-treatment fMRI scans, youth in FFT-HR had (a) stronger resting state connectivity between ventrolateral PFC and anterior default mode network, and (b) increased activity of dorsolateral and medial PFC in emotion processing and problem-solving tasks, compared to youth in enhanced care. FFT-HR may delay new mood episodes in symptomatic youth with familial liability to BD. Putative treatment mechanisms include neural adaptations suggestive of improved emotion regulation. Early Intervention for Youth at Risk for Bipolar Disorder; https://clinicaltrials.gov/; NCT01483391.
DOI：
10.1016/j.pnpbp.2014.09.007
发表时间：
2015-01-02
影响因子：
5.6
作者：
Garrett, Amy S.;Miklowitz, David J.;Howe, Meghan E.;Singh, Manpreet K.;Acquaye, Tenah K.;Hawkey, Christopher G.;Glover, Gary H.;Reiss, Allan L.;Chang, Kiki D.
通讯作者：
Chang, Kiki D.