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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH073871-05
Application #
7809640
Study Section
Special Emphasis Panel (ZMH1-ERB-P (07))
Program Officer
Sherrill, Joel
Project Start
2006-07-01
Project End
2012-04-30
Budget Start
2010-05-01
Budget End
2012-04-30
Support Year
5
Fiscal Year
2010
Total Cost
$226,140
Indirect Cost
Name
University of Colorado at Boulder
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
007431505
City
Boulder
State
CO
Country
United States
Zip Code
80309
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Miklowitz, David J; Schneck, Christopher D; George, Elizabeth L et al. (2014) Pharmacotherapy and family-focused treatment for adolescents with bipolar I and II disorders: a 2-year randomized trial. Am J Psychiatry 171:658-67
Miklowitz, David J; Schneck, Christopher D; Birmaher, Boris et al. (2014) Response to Parikh. Am J Psychiatry 171:1335-6
Goldstein, Benjamin I; Goldstein, Tina R; Collinger, Katelyn A et al. (2014) Treatment development and feasibility study of family-focused treatment for adolescents with bipolar disorder and comorbid substance use disorders. J Psychiatr Pract 20:237-48
Miklowitz, David J; Schneck, Christopher D; Singh, Manpreet K et al. (2013) Early intervention for symptomatic youth at risk for bipolar disorder: a randomized trial of family-focused therapy. J Am Acad Child Adolesc Psychiatry 52:121-31
Keenan-Miller, Danielle; Peris, Tara; Axelson, David et al. (2012) Family functioning, social impairment, and symptoms among adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 51:1085-94
Miklowitz, David J (2012) Family treatment for bipolar disorder and substance abuse in late adolescence. J Clin Psychol 68:502-13
Sullivan, Aimee E; Judd, Charles M; Axelson, David A et al. (2012) Family functioning and the course of adolescent bipolar disorder. Behav Ther 43:837-47
Cosgrove, Victoria E; Miklowitz, David J; Rhee, Soo Hyun et al. (2012) Association between 5HTT, DAT1, and DRD4 and bipolar disorder in youth. Psychiatr Genet 22:304
Miklowitz, David J; Price, Jonathan; Holmes, Emily A et al. (2012) Facilitated Integrated Mood Management for adults with bipolar disorder. Bipolar Disord 14:185-97

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