There is increasing evidence that social-environmental factors, particularly those within the family, are significant predictors of the course of major psychiatric disorders. Studies of schizophrenic patients and their family members indicate that levels of intrafamilial expressed emotion (EE) (emotional attitudes measured during an inpatient period) and affective style (AS) interactional behaviors (measured during an outpatient, aftercare period) in key relatives are strongly associated with the subsequent likelihood of psychotic relapse in patients. The proposed study will investigate whether the emotional climate of the family predicts the course of bipolar affective disorder, and whether family climate, in turn, is predicted by patient factors of known prognostic significance. The study asks three major questions: (1) Does the emotional climate of the family (EE and AS) predict the clinical and social adjustment course of bipolar disorder over the 2 years following an index hospitalization? (2) Are these family factors, their relative stability over time, and their association with patient outcomes mediated by patient attributes with known prognostic significance (medication compliance, symptom severity, associated Axis II disorders)? (3) What attributes of parents and patients predict the emotional climate of the family after an episode of bipolar disorder (psychopathology in parents, family history of affective disorder, personality disorders or temperamental disturbances in patients, or patients' attitudes toward or styles of interacting with parents)? These questions will be investigated in 75 initially hospitalized DSM- III-R bipolar, manic patients followed over a 2-year period and maintained on a standardized pharmacology regimen administered by study psychiatrists. Assessments of EE and AS in parents, and emotional attitudes/interactional behaviors in patients, will be conducted at baseline and at a 1-year follow-up. Psychopathology in parents, family history of affective disorder, and personality disorders/temperamental disturbances in patients will be assessed using structured interviews and self-report measures. Patients will be interviewed every 3 months over the 2-year follow-up using measures of symptomatology, social adjustment, substance and alcohol abuse, and medication compliance.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
First Independent Research Support & Transition (FIRST) Awards (R29)
Project #
1R29MH043931-01A2
Application #
3474950
Study Section
Psychopathology and Clinical Biology Research Review Committee (PCB)
Project Start
1991-09-30
Project End
1996-08-31
Budget Start
1991-09-30
Budget End
1992-08-31
Support Year
1
Fiscal Year
1991
Total Cost
Indirect Cost
Name
University of Colorado at Boulder
Department
Type
Schools of Arts and Sciences
DUNS #
City
Boulder
State
CO
Country
United States
Zip Code
80309
Stange, Jonathan P; Sylvia, Louisa G; da Silva Magalhães, Pedro Vieira et al. (2016) Affective instability and the course of bipolar depression: results from the STEP-BD randomised controlled trial of psychosocial treatment. Br J Psychiatry 208:352-8
Fredman, Steffany J; Baucom, Donald H; Boeding, Sara E et al. (2015) Relatives' emotional involvement moderates the effects of family therapy for bipolar disorder. J Consult Clin Psychol 83:81-91
Peters, A; Sylvia, L G; Magalhães, P V da Silva et al. (2014) Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Psychol Med 44:3455-67
Deckersbach, Thilo; Peters, Amy T; Sylvia, Louisa et al. (2014) Do comorbid anxiety disorders moderate the effects of psychotherapy for bipolar disorder? Results from STEP-BD. Am J Psychiatry 171:178-86
Stange, Jonathan P; Sylvia, Louisa G; Magalhães, Pedro Vieira da Silva et al. (2013) Extreme attributions predict transition from depression to mania or hypomania in bipolar disorder. J Psychiatr Res 47:1329-36
Stange, Jonathan P; Sylvia, Louisa G; da Silva Magalhães, Pedro Vieira et al. (2013) Extreme attributions predict the course of bipolar depression: results from the STEP-BD randomized controlled trial of psychosocial treatment. J Clin Psychiatry 74:249-55
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
Miklowitz, David J; Otto, Michael W; Frank, Ellen et al. (2007) Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry 64:419-26
Miklowitz, David J; Otto, Michael W; Frank, Ellen et al. (2007) Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial. Am J Psychiatry 164:1340-7
Miklowitz, David J; Biuckians, Adrine; Richards, Jeffrey A (2006) Early-onset bipolar disorder: a family treatment perspective. Dev Psychopathol 18:1247-65

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