Dialectical Behavior Therapy (DBT) for Adolescents with Bipolar Disorder

描述（由申请人提供）：在所有精神病诊断中，双相情感障碍（BP）是青少年自杀完成的最大风险，并与其他负面结果相关，包括心理社会功能不良和药物滥用。此外，患有BP的青少年的医疗费用超过了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，对这一人群的有效心理治疗方法知之甚少，没有明确针对自杀倾向。一个有效的，成本效益的心理治疗青少年与BP有很大的潜力，以减少大量的发病率，死亡率和成本与这种疾病。辩证行为疗法（Dialectical Behavior Therapy，DBT）是一种基于技能的心理疗法，最初是为边缘型人格障碍的成年人开发的。DBT为BP青少年提供了共同的治疗目标，包括自杀和心理社会功能。我们小组关于青少年BP DBT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与目标治疗领域的改善相关，包括自杀，情绪失调和抑郁，与我们的儿童和青少年双相服务提供的标准护理（SOC）心理治疗相比，接受DBT的青少年的这些改善更大（CABS）专科诊所。拟定研究旨在通过一项随机对照试验，在2年随访期间，在患有BP的青少年（12-18岁）（n=100）中评价DBT +药物治疗与CABS SOC心理治疗+药物治疗相比的疗效。主要结局领域包括自杀事件和情绪症状。我们的团队包括一名医疗服务成本效益专家，使我们能够检查DBT的成本效益。我们的探索性目的是阐明该人群中DBT治疗反应的调节剂和介导剂。识别预测DBT反应的患者因素，以及DBT使患者受益的机制，将直接为最有可能受益的患者提供有计划的治疗传播（如果证明有效）。这些目标与NIMH战略计划直接雅阁，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循证干预措施的广泛使用;并系统地研究个性化干预措施的要素。此外，该项目符合自杀预防研究优先工作组国家行动联盟的使命：优先考虑研究中的差距，这将降低自杀率和自杀企图，特别是针对高风险群体，并走向自杀的循证干预措施。

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.