Family-Focused Therapy as Early Treatment for Youth at Risk for Bipolar Disorder

以家庭为中心的治疗作为双相情感障碍风险青少年的早期治疗

• 批准号: 7575615
• 负责人: DAVID Jay MIKLOWITZ
• 金额: $ 20.53万
• 依托单位: UNIVERSITY OF COLORADO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7575615
• 关键词: Adolescent; Adult; Advocate; Aftercare; Age; Behavioral Symptoms; Bipolar Disorder; Child; Child Health Services; Colorado; Communication; Confidence Intervals; Consumer Satisfaction; Cyclothymic Disorder; DSM-IV; Data; Deterioration; Development; Diagnosis; Diagnostic; Disease; Disease remission; Distress; Early intervention trials; Early treatment; Effectiveness; Emotional; Enrollment; Family; Family Relationship; Family history of; Family member; Feasibility Studies; Feedback; First Degree Relative; Goals; Health Care Costs; Impairment; Individual; Intervention; Intervention Studies; Lead; Life; Major Depressive Disorder; Manic; Manuals; Mental Health Services; Modeling; Mood stabilizers; Moods; Morbidity - disease rate; Outcome; Parents; Participant; Patients; Pharmacotherapy; Phase; Population; Practice Guidelines; Principal Investigator; Problem Solving; Procedures; Process; Protocols documentation; Psychiatrist; Puberty; Public Health; Randomized; Randomized Controlled Clinical Trials; Recurrence; Relapse; Research; Resistance; Risk; Risk Factors; Schools; Self Care; Severities; Siblings; Site; Social Functioning; Specific qualifier value; Suicide; Symptoms; Testing; Time; Training; Universities; Work; Youth; aged; base; brief intervention; child depression; child mental health service; coping; cost; depressive symptoms; disability; early onset; effective therapy; follow-up; functional outcomes; high risk; hypomania; improved; improved functioning; meetings; pilot trial; prevent; primary outcome; proband; programs; psychoeducation; psychoeducational intervention; psychosocial; response; secondary outcome; skills; skills training; social; stressor; success; therapy development; treatment as usual; treatment site

Bipolar disorder (BD) in youth is associated with significant impairments in functioning, treatment-resistance, and high public health costs. Recent research on prodromal forms of BD have identified symptomatic risk factors which increase the chances that genetically predisposed children will develop BD I or II disorder. The long-term goal of our research is to reduce the likelihood of or delay the full expression of BD among at-risk youth. The aim of this first phase (R34) is to develop and test a manual-based early psychoeducational intervention - family-focused treatment (FFT) - to determine if a large-scale early intervention trial with longer follow-up is warranted. FFT, consisting of psychoeducation, communication enhancement training, and problem-solving skills training, has been found to be effective in combination with pharmacotherapy in preventing recurrences and stabilizing the symptoms of adults and adolescents with BD. The present study consists of two phases and will be conducted at two sites: the University of Colorado (primary applicant site; D. Miklowitz, PI) and Stanford University (secondary site; K. Chang, Co-PI). In Phase I, we will identify 12 children aged 9-17 with putative prodromal BD who meet study criteria for high risk (i.e., have a first-degree relative with bipolar I or II disorder and meet criteria for BD not otherwise specified, cyclothymia, or major depressive disorder with hypomanic symptoms). In phase I, we will develop a manual for a 4-month, 12-session version of FFT for children at risk for BD, test therapist fidelity scales, and revise the manual in an iterative fashion in response to clinician and consumer feedback. We will examine consumer acceptance of the intervention and pre/post changes in the symptoms and functioning of the at-risk children (depression and mania scores, psychiatric status on the Adolescent Longitudinal Interval Follow-up) over a 1-year period. In phase II, we will randomly assign 40 high-risk children to either the newly manualized FFT or a treatment-as-usual (TAU) comparison. All children who require pharmacotherapy will receive it from study psychiatrists following best- practice guidelines. Participants in phase II will be examined over one year to test the hypothesis that FFT is more effective than TAU in reducing the severity of manic and depressive symptoms, increasing the amount of time spent well, delaying the onset of first manic, mixed or hypomanic episodes, improving functioning, decreasing distress among parents, and increasing the child's access to appropriate mental health services. The data analytic plan emphasizes mixed effects regression and survival analytic models. With 40 participants, phase II is well-powered to detect large and medium effect sizes assuming expected rates of attrition. The pilot trial will produce a finalized treatment manual that should be exportable to other treatment sites. It will yield estimates of population variability in targeted outcomes as a function of treatments, which should inform the development of a larger-scale early intervention trial. Principal Investigator/Program Director: Miklowitz, David J.

青年双相情感障碍（BD）与功能的显著损害、治疗抵抗和高昂的公共卫生费用有关。最近对BD前驱形式的研究已经确定了有症状的风险因素，这些风险因素增加了遗传易感儿童发展BD I或II障碍的机会。我们研究的长期目标是减少高危青少年中BD完全表达的可能性或延迟。第一阶段（R34）的目的是开发和测试一种基于手册的早期心理教育干预-以家庭为中心的治疗（FFT）-以确定是否需要进行大规模的早期干预试验，并进行更长时间的随访。FFT，包括心理教育，沟通增强训练和解决问题的技能训练，已被发现是有效的结合药物治疗，在预防复发和稳定的症状，成人和青少年与BD。本研究由两个阶段组成，将在两个地点进行：科罗拉多大学（主要申请地点; D. Miklowitz，PI）和斯坦福大学（二级站点; K. Chang，Co-PI）。在第一阶段，我们将确定12名9-17岁的儿童患有假定的前驱BD，他们符合高风险的研究标准（即，有I型或II型双相情感障碍的一级亲属，并符合BD（未另行说明）、循环性心境障碍或重度抑郁症伴轻躁狂症状的标准）。在第一阶段，我们将为BD风险儿童开发一个为期4个月、12个疗程的FFT版本手册，测试治疗师忠诚度量表，并根据临床医生和消费者的反馈以迭代方式修订手册。我们将检查消费者接受的干预和前/后的变化的症状和功能的高危儿童（抑郁和躁狂评分，精神状态的青少年纵向间隔随访）超过1年的时间。在第二阶段，我们将40名高危儿童随机分配到新手动FFT或常规治疗（TAU）比较。所有需要药物治疗的儿童将按照最佳实践指南从研究精神科医生处接受药物治疗。第二阶段的参与者将接受为期一年的检查，以检验FFT在降低躁狂和抑郁症状的严重程度，增加良好生活的时间，延迟首次躁狂，混合或轻躁狂发作，改善功能，减少父母的痛苦，以及增加儿童获得适当心理健康服务方面比TAU更有效的假设。数据分析计划强调混合效应回归和生存分析模型。有40名参与者，第二阶段是充分的权力，以检测大，中的效果大小假设预期率的流失。试点试验将产生一个最终的治疗手册，应出口到其他治疗地点。它将产生作为治疗函数的目标结果的人群变异性的估计，这应该为更大规模的早期干预试验的发展提供信息。主要研究者/项目负责人：Miklowitz，大卫J。

项目成果

Using machine learning analyses of speech to classify levels of expressed emotion in parents of youth with mood disorders.

• DOI: 10.1016/j.jpsychires.2021.01.019
• 发表时间: 2021-04
• 期刊: Journal of psychiatric research
• 影响因子: 4.8
• 作者: Weintraub MJ;Posta F;Arevian AC;Miklowitz DJ
• 通讯作者: Miklowitz DJ

Longitudinal trajectories of mood symptoms and global functioning in youth at high risk for bipolar disorder.

• DOI: 10.1016/j.jad.2020.08.018
• 发表时间: 2020-12-01
• 期刊: Journal of affective disorders
• 影响因子: 6.6
• 作者: Weintraub MJ;Schneck CD;Walshaw PD;Chang KD;Sullivan AE;Singh MK;Miklowitz DJ
• 通讯作者: Miklowitz DJ

A Pharmacologic Algorithm for Youth Who Are at High Risk for Bipolar Disorder.

针对双相情感障碍高风险青少年的药理学算法。

• DOI: 10.1089/cap.2017.0035
• 发表时间: 2017
• 期刊: Journal of child and adolescent psychopharmacology
• 影响因子: 1.9
• 作者: Schneck,ChristopherD;Chang,KikiD;Singh,ManpreetK;DelBello,MelissaP;Miklowitz,DavidJ
• 通讯作者: Miklowitz,DavidJ

Social impairment in relation to clinical symptoms in youth at high risk for bipolar disorder.

• DOI: 10.1111/eip.13124
• 发表时间: 2022-01
• 期刊: Early intervention in psychiatry
• 影响因子: 2
• 作者: Weintraub MJ;Keenan-Miller D;Schneck CD;Forgey Borlik M;Suddath RL;Marvin SE;Singh MK;Chang KD;Miklowitz DJ
• 通讯作者: Miklowitz DJ