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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21MH062555-02
Application #
6539199
Study Section
Special Emphasis Panel (ZRG1-BBBP-6 (01))
Program Officer
Sherrill, Joel
Project Start
2001-07-26
Project End
2004-06-30
Budget Start
2002-07-01
Budget End
2003-06-30
Support Year
2
Fiscal Year
2002
Total Cost
$159,692
Indirect Cost
Name
University of Colorado at Boulder
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
City
Boulder
State
CO
Country
United States
Zip Code
80309
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Miklowitz, David J (2011) Functional impairment, stress, and psychosocial intervention in bipolar disorder. Curr Psychiatry Rep 13:504-12
Sullivan, Aimee E; Miklowitz, David J (2010) Family functioning among adolescents with bipolar disorder. J Fam Psychol 24:60-7
Miklowitz, David J; Axelson, David A; George, Elizabeth L et al. (2009) Expressed emotion moderates the effects of family-focused treatment for bipolar adolescents. J Am Acad Child Adolesc Psychiatry 48:643-51
Miklowitz, David J; Johnson, Sheri L (2009) Social and Familial Factors in the Course of Bipolar Disorder: Basic Processes and Relevant Interventions. Clin Psychol (New York) 16:281-296
Miklowitz, David J; Axelson, David A; Birmaher, Boris et al. (2008) Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial. Arch Gen Psychiatry 65:1053-61
Fredman, Steffany J; Baucom, Donald H; Miklowitz, David J et al. (2008) Observed emotional involvement and overinvolvement in families of patients with bipolar disorder. J Fam Psychol 22:71-9

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