Family-Focused Psychoeducation for Bipolar Adolescents

描述（由申请人提供）：早发性双相情感障碍是一种主要的 对受影响的个人的健康风险。患有DSM-IV双相I型障碍的青少年 有很高的风险住院，社交和学术恶化， 自杀、药物滥用和药物不依从。治疗研究 对于双相青少年的研究已经落后于成人的研究，特别是在 心理社会竞技场。一个有前途的社会心理模式是以家庭为中心的 治疗（FFT），包括对患者和亲属的心理教育 关于双相情感障碍，沟通增强训练，和解决问题 训练在两项随机试验中，FFT被发现是一种有效的辅助治疗方法。 在成人双相I型障碍的2年疗程中进行药物治疗。我们提出 开发和标准化FFT版本， 青少年双相I型患者的发展需求，并测试其疗效 在成人和儿童发病的两个专业中心进行药物治疗 双相情感障碍：科罗拉多大学和匹兹堡医学大学 中心在第一阶段（仅科罗拉多），12名双相I型青少年和父母将 参加为期9个月的FF 1开放试验，根据 在可行性测试中开发的初步的以可预测性为重点的手册（FFT-A）。 青少年将接受药物治疗，使用临床 管理手册。基于第1阶段，我们将修改FF 1-A手册， 最大限度地提高青少年的发展敏感性和参与度， 标准化治疗师依从性和能力量表。在第二阶段（科罗拉多）， 我们会进一步修订和精简FF 1-A模式， 第一阶段青少年和家长、治疗师和精神科医生的反馈。在 第3阶段（科罗拉多和匹兹堡），我们将进行一项初步随机试验（N = 50）的简化FF 1-A+药物治疗（n = 25）与 常规治疗（TAU;教育自助手册）加 药物治疗25例。不知道治疗分配的评定者将 评估患者在基线、3、6、9和12个月的结局。我们假设 FFT-A在改善青少年症状方面优于TAU，具有上级作用 轨迹、社会/学校功能和药物依从性，以及 减少了他们对辅助卫生服务的需求。次要分析将 检查FFT-A对父母情绪状态和主观痛苦的影响， 以及其他假设的中介机制：家庭表达的情感， 家庭干预行为和社会节奏稳定。

DESCRIPTION (provided by applicant): Early-onset bipolar disorder poses a major health risk to affected individuals. Adolescents with DSM-IV bipolar I disorder are at high risk for hospitalizations, social and academic deterioration, suicide, substance abuse, and pharmacological nonadherence. Treatment research for bipolar adolescents has lagged behind research for adults, particularly in the psychosocial arena. A promising psychosocial model is family-focused treatment (FFT), consisting of psychoeducation for the patient and relatives about bipolar disorder, communication enhancement training, and problem-solving training. In two randomized trials, FFT was found to be an efficacious adjunct to pharmacotherapy in the 2-year course of adult bipolar I disorder. We propose developing and standardizing a version of FFT that is attuned to the developmental needs of adolescent bipolar I patients, and testing its efficacy with pharmacotherapy at two centers of expertise in adult and pediatric-onset bipolar disorders: the Univ. of Colorado and the Univ. of Pittsburgh Medical Center. In Phase I (Colorado only), 12 bipolar I adolescents and parents will participate in an open trial of 9-month FF1, delivered according to a preliminary adolescent-focused manual (FFT-A) developed in feasibility testing. The adolescents will be treated with pharmacotherapy using a clinical management manual. Based on Phase 1, we will modify the FF1-A manual to maximize its developmental sensitivity and engagement of adolescents, and standardize therapist adherence and competence scales. In Phase 2 (Colorado), we will further revise and streamline the FF1-A model through incorporating the feedback of Phase I adolescents and parents, therapists, and psychiatrists. In Phase 3 (Colorado and Pittsburgh), we will conduct a pilot randomized trial (N = 50) of the streamlined FF1-A plus pharmacotherapy (n = 25) versus treatment-as-usual (TAU; an educational self-help workbook) plus pharmacotherapy (n = 25). Raters who are unaware of treatment assignments will assess patients' outcomes at baseline, 3, 6, 9, and 12 months. We hypothesize that FFT-A will be superior to TAU in improving adolescents' symptom trajectories, social/school functioning, and adherence to medication, and decreasing their need for ancillary health services. Secondary analyses will examine the impact of FFT-A on parents' mood states and subjective distress, and on other hypothesized mediating mechanisms: family expressed emotion, family interactional behavior, and social rhythm stability.