Family-Focused Treatment for Bipolar Adolescents

描述(由申请人提供)：患有双相情感障碍(BP)的青少年即使在积极接受情绪稳定剂和抗精神病药物治疗时，也有很高的复发率、自杀企图、功能障碍和服务利用率。尽管它有相当大的公共健康风险，但目前还没有针对患有BP的青少年的基于经验的、特定于障碍的心理社会干预措施。这项为期5年的研究将在一项三点随机试验(科罗拉多大学[协调地点；D.Miklowitz，PI]、匹兹堡大学[D.Axelson，PI]和Cinn)中测试一种有希望的青少年BP新干预措施--家庭重点治疗(FFT)的有效性，作为谨慎对照药物治疗的辅助手段。儿童[R·科瓦奇，派])。FFT是一项为期9个月的干预措施，包括心理教育、沟通培训和问题解决，在科罗拉多州和匹兹堡进行的一项为期1年的治疗发展研究中，FFT在青少年中的临床改善显著。我们将150个BP I或BP II青少年(50个/站点)随机分为：(1)快速傅立叶变换加药物治疗或(2)短暂心理教育(加强护理或EC)加药物治疗。随机化将在部位、双相I型和疾病极性上分层。药物治疗将遵循一套由药物治疗委员会密切监督的最佳实践指南。结果评估包括K-SADS和在两年中每隔3-6个月对父母和青少年进行的纵向间隔随访评估。生存和混合效应回归模型将检验这样的假设：与EC和药物治疗相比，快速傅立叶变换和药物治疗可以加速康复、推迟复发、减少躁狂和抑郁症状、提高功能和生活质量，并减少辅助服务的利用。二次分析将检验关于治疗调节因素的两个假设(家族性情绪表达，基线症状严重程度)和两个中介假设：与治疗相关的家庭功能改善预测抑郁症状的稳定，而服药依从性和睡眠/清醒规律的改善预测躁狂症状的稳定。最后，我们将比较治疗的相对成本。研究完成后，我们将获得帮助开发BP青少年治疗的最佳实践模式的知识库，该模式将以家庭为重点的问题解决与精神药理学相结合。

DESCRIPTION (provided by applicant): Adolescents with bipolar disorder (BP) have high rates of recurrence, suicide attempts, functional impairment, and service utilization even when aggressively treated with mood stabilizers and antipsychotics. Despite its considerable public health risk, there are no empirically-based, disorder-specific psychosocial interventions for adolescents with BP. This 5-year study will test the efficacy of a promising new intervention for BP adolescents, family-focused treatment (FFT), as adjunct to carefully controlled pharmacotherapy in a 3-site randomized trial (U. of Colorado [coordinating site; D. Miklowitz, PI], U. of Pittsburgh [D. Axelson, PI], and Cinn. Childrens [R. Kowatch, PI]). FFT, a 9-month intervention consisting of psychoeducation, communication training, and problem-solving, led to significant clinical improvements among adolescents in a 1-year treatment development study at Colorado and Pittsburgh. We will randomize 150 BP I or BP II adolescents (50/site) with a recent acute affective episode to: (1) FFT plus pharmacotherapy or (2) brief psychoeducation (enhanced care, or EC) plus pharmacotherapy. Randomization will stratify on site, bipolar I, and illness polarity. Pharmacotherapy will follow a set of best practice guidelines as closely monitored by a pharmacotherapy committee. Outcome assessments include the K-SADS and the Longitudinal Interval Follow-up Evaluation given to parents and adolescents every 3-6 months over 2 years. Survival and mixed effects regression models will test the hypotheses that FFT and pharmacotherapy hasten recovery, delay recurrences, reduce manic and depressive symptoms, enhance functioning and quality of life, and reduce ancillary service utilization when compared to EC and pharmacotherapy. Secondary analyses will test two hypotheses concerning treatment moderators (familial expressed emotion, baseline symptom severity) and two mediational hypotheses: treatment-associated improvements in family functioning predict the stabilization of depressive symptoms, whereas improvements in medication adherence and sleep/wake regularity predict the stabilization of manic symptoms. Finally, we will compare the relative costs of treatments. At the study's completion, we will have obtained a knowledge base to help develop a best practice model of treatment for BP adolescents that integrates family-focused problem-solving with psychopharmacology.