Family-Focused Therapy for Individuals at High Clinical Risk for Psychosis: A Confirmatory Efficacy Trial

针对精神病临床高风险个体的以家庭为中心的治疗：一项验证性疗效试验

• 批准号: 10674012
• 负责人: CARRIE E BEARDEN
• 金额: $ 92.23万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-07 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10674012
• 关键词: Acceleration; Achievement; Acute; Adolescence; Adolescent; Adolescent and Young Adult; Aftercare; Age; American; Attenuated; Behavior; Behavioral; Bipolar Disorder; Case Management; Clinical; Communication; Conflict (Psychology); Deterioration; Development; Diagnostic; Disease remission; Distal; Early Intervention; Education; Emotional; Enrollment; Evidence based intervention; Family; Family Relationship; Family Study; Functional disorder; Individual; Intervention; Interview; Laboratories; Longitudinal Studies; Measurement; Measures; Mediating; Mental disorders; Methodology; Moods; Outcome; Parents; Participant; Patients; Perception; Persons; Population; Problem Solving; Psychoses; Psychotic Disorders; Questionnaires; Randomized; Research; Risk; Sampling; Severities; Site; Social Functioning; Structure; Symptoms; Syndrome; Testing; Time; Training; Validation; Youth; attenuated psychosis syndrome; blind; clinical high risk for psychosis; communication behavior; confirmatory clinical trial; confirmatory trial; enhanced care; evidence base; experience; follow-up; functional outcomes; high risk; high risk population; improved; mobile application; offspring; participant interview; preventive intervention; primary outcome; proband; psychoeducation; psychoeducational; psychosis risk; psychosocial; psychotic; psychotic symptoms; randomized trial; randomized, clinical trials; recruit; reduce symptoms; relapse prevention; remote monitoring; response; secondary outcome; skills; skills training; smartphone application; social; social engagement; symptom management; therapy design; treatment as usual; young adult

Project Summary This proposal responds to RFA-MH-18-707, “Confirmatory Efficacy Clinical Trials of Non-Pharmacological Interventions for Mental Disorders (R01).” Adolescents and young adults at clinical high risk (CHR) for psychosis, characterized by recent onset or worsening of attenuated positive symptoms (APS), have a 16%-30% risk of converting to a psychotic disorder in 2 years. In a prior randomized trial in the North American Prodrome Longitudinal Study (NAPLS) network, we showed that family-focused therapy for clinical high-risk persons (FFT- CHR) was more effective than brief family education in (a) improving family (offspring/parent) communication and (b) reducing APS over 6 months, particularly among CHR youth with high baseline scores on a measure of individual risk of psychosis conversion. Both treatments were associated with reductions in young people's perceptions of criticism from parents, which in turn were associated with decreases in APS over 12 months. These findings led us to hypothesize enhanced family communication as a mechanism of action of FFT-CHR. FFT-CHR consists of 18 sessions in 6 months of psychoeducation, communication training, and problem-solving skills training. In the present study conducted in 7 NAPLS sites, we will randomly assign 220 CHR individuals (ages 13-25) and their parent(s) to FFT-CHR or a 6-month Enhanced Care (EC) treatment, consisting of 3 family educational sessions followed by 5 months of individual support and case management. CHR individuals will be interviewed and fill out questionnaires regarding APS (primary outcome) and social functioning (secondary) every 6 months over 18 months. We will examine behavioral targets indicative of improved family relationships: reductions in proportion of critical-conflictual statements and increases in proportion of calm-constructive statements of parents and CHR offspring in laboratory family interactional assessments conducted at baseline and end of treatment (6 months). We will also capture granular changes in targets and outcomes through remote monitoring: CHR participants in both conditions will enroll in a newly developed mobile phone app to facilitate weekly proband ratings of perceived criticism, appraisals of family interactions, and primary and secondary outcomes. We hypothesize that (1) youth/young adults in FFT-CHR will show greater improvements in APS than those in EC in 6 months; (2) improvements in parent and offspring communication by 6 months will be associated with downstream improvements in APS and social functioning over 18 months; and improvements in parent and offspring communication by 6 months will mediate the relationship between treatment condition and changes in primary and secondary outcomes over 18 months. We hypothesize that individuals who are at higher baseline risk of psychosis conversion will show more improvement in targets and primary and secondary outcomes in FFT-CHR than EC, compared to those at lower conversion risk. The involvement of 7 collaborative NAPLS sites with complementary expertise will assure accelerated recruitment of the sample, diagnostic reliability, sample diversity, and treatment exportability.

项目总结

项目成果

A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention.

• DOI: 10.1186/s40345-022-00275-3
• 发表时间: 2023-01-03
• 期刊: INTERNATIONAL JOURNAL OF BIPOLAR DISORDERS
• 影响因子: 4
• 作者: Ratheesh, A.;Hett, D.;Ramain, J.;Wong, E.;Berk, L.;Conus, P.;Fristad, M. A.;Goldstein, T.;Hillegers, M.;Jauhar, S.;Kessing, L., V;Miklowitz, D. J.;Murray, G.;Scott, J.;Tohen, M.;Yatham, L. N.;Young, A. H.;Berk, M.;Marwaha, S.
• 通讯作者: Marwaha, S.

Family-focused therapy for individuals at high clinical risk for psychosis: A confirmatory efficacy trial.

• DOI: 10.1111/eip.13208
• 发表时间: 2022-06
• 期刊: Early intervention in psychiatry
• 影响因子: 2
• 作者: Miklowitz DJ;Addington JM;O'Brien MP;Denenny DM;Weintraub MJ;Zinberg JL;Mathalon DH;Cornblatt BA;Friedman-Yakoobian MS;Stone WS;Cadenhead KS;Woods SW;Sugar CA;Cannon TD;Bearden CE
• 通讯作者: Bearden CE

Family communication and the efficacy of family focused therapy in individuals at clinical high risk for psychosis with comorbid anxiety.

• DOI: 10.1111/eip.13326
• 发表时间: 2023-03
• 期刊: Early intervention in psychiatry
• 影响因子: 2
• 作者: O'Brien Cannon AC;Caporino NE;O'Brien MP;Miklowitz DJ;Addington JM;Cannon TD
• 通讯作者: Cannon TD

Early Family Intervention for Youth at Risk for Bipolar Disorder: Psychosocial and Neural Mediators of Outcome.

• DOI: 10.2174/1570159x21666230111120817
• 发表时间: 2023
• 期刊: Current neuropharmacology
• 影响因子: 5.3

Changes in Intrinsic Brain Connectivity in Family-Focused Therapy Versus Standard Psychoeducation Among Youths at High Risk for Bipolar Disorder.

• DOI: 10.1016/j.jaac.2020.07.892
• 发表时间: 2021-04
• 期刊: Journal of the American Academy of Child and Adolescent Psychiatry
• 影响因子: 13.3
• 作者: Singh MK;Nimarko AF;Garrett AS;Gorelik AJ;Roybal DJ;Walshaw PD;Chang KD;Miklowitz DJ
• 通讯作者: Miklowitz DJ