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: 8893532
• 负责人: TINA R GOLDSTEIN
• 金额: $ 9.41万
• 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 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8893532
• 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; Relative (related person); Research; Risk; Services; Severities; Strategic Planning; Substance abuse problem; Suicide; Suicide attempt; Suicide prevention; Symptoms; System; Targeted Research; Youth; accomplished suicide; base; childhood bipolar disorder; cost; cost effective; cost effectiveness; depressive symptoms; early onset; effective therapy; emotion dysregulation; follow-up; high risk; ideation; improved; inpatient psychiatric treatment; medical specialties; mortality; personalized intervention; primary outcome; psychosocial; response; 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）是青少年自杀风险最高的，并与其他负面结果相关，包括不良的社会心理功能和药物滥用。此外，青少年BP的医疗保健费用高于其他青少年精神疾病。治疗指南指出，儿童BP的最佳管理包括药物治疗和心理治疗的结合。然而，对这一人群有效的心理治疗方法知之甚少，也没有明确针对自杀的方法。对于患有BP的青少年，一种有效的、经济有效的心理治疗具有巨大的潜力，可以降低与该疾病相关的大量发病率、死亡率和费用。辩证行为疗法（DBT）是一种以技能为基础的心理治疗，最初是为边缘型人格障碍的成年人开发的。DBT为BP青少年提供了包括自杀和心理社会功能在内的共同治疗目标。我们小组关于青少年BP患者DBT治疗的初步数据为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与包括自杀、情绪失调和抑郁在内的目标治疗领域的改善有关，并且与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）心理治疗相比，接受DBT治疗的青少年的改善更大。该研究旨在通过一项随机对照试验来评估DBT +药物治疗与CABS SOC心理治疗+药物治疗在患有BP的青少年（n=100）中2年随访的疗效。主要结局域包括自杀事件和情绪症状。我们的团队包括一名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。我们的探索目的是阐明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，将直接告知有计划地向最有可能受益的患者传播治疗（如果证明有效）。这些目标与NIMH战略计划直接一致，即优先研究改善精神疾病的治疗方法；通过证明成本效益，促进以证据为基础的干预措施的广泛使用；系统地研究个性化干预的要素。此外，该项目与全国自杀预防研究优先工作组行动联盟的使命相一致：优先考虑降低自杀率和自杀未遂率的研究差距，针对特别高风险群体，并朝着采用循证干预自杀的方向发展。