Dialectical Behavior Therapy (DBT) for Adolescents with Bipolar Disorder

描述(申请人提供)：在所有精神病诊断中，双相情感障碍(BP)在青春期具有最大的完全自杀风险，并与其他负面后果有关，包括心理社会功能低下和药物滥用。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的费用。治疗指南指出，儿科BP的最佳治疗包括药物治疗和心理治疗的结合。然而，人们对这一群体的有效心理治疗方法知之甚少，也没有明确针对自杀的方法。一种有效的、成本效益高的青少年BP心理疗法在降低与这种疾病相关的大量发病率、死亡率和成本方面具有巨大的潜力。辩证行为疗法(DBT)是一种以技能为基础的心理疗法，最初是为患有边缘性人格障碍的成年人开发的。DBT有望为患有BP的青少年提供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DBT治疗患有BP的青少年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与靶向治疗领域的改善有关，包括自杀、情绪失调和抑郁，与在我们的儿童和青少年双相情感服务(CABS)专科诊所提供的标准护理(SOC)心理治疗相比，接受DBT的青少年的这些改善更大。这项拟议的研究旨在通过随机对照试验评估DBT药物治疗与CABS SOC心理治疗药物治疗的疗效，并对患有BP的青少年(n=100)进行超过2年的随访。主要结果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方面的专家，使我们能够检查DBT的成本效益。我们的探索性目标是阐明DBT治疗反应的调节因子和中介因子。确定预测DBT反应的患者因素，以及DBT使患者受益的机制，将直接为那些最有可能受益的患者计划传播治疗(如果被证明有效)提供信息。这些目标与NIMH战略计划直接一致，该战略计划将改善精神疾病治疗的研究放在优先位置；通过证明成本效益促进循证干预措施的广泛使用；以及系统地研究个性化干预措施的要素。此外，该项目与全国预防自杀研究优先行动联盟工作队的使命一致：优先处理研究中的差距，以降低自杀和自杀未遂的比率，特别针对高危群体，并朝着采用自杀的循证干预措施的方向发展。

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.