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Early intervention for symptomatic youth at risk for bipolar disorder: a randomized trial of family-focused therapy. J Am Acad Child Adolesc Psychiatry 2013; 52:121-31. [PMID: 23357439 PMCID: PMC3558946 DOI: 10.1016/j.jaac.2012.10.007] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/01/2012] [Accepted: 10/12/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Depression and brief periods of (hypo)mania are linked to an increased risk of progression to bipolar I or II disorder (BD) in children of bipolar parents. This randomized trial examined the effects of a 4-month family-focused therapy (FFT) program on the 1-year course of mood symptoms in youth at high familial risk for BD, and explored its comparative benefits among youth in families with high versus low expressed emotion (EE). METHOD Participants were 40 youth (mean 12.3±2.8 years, range 9-17) with BD not otherwise specified, major depressive disorder, or cyclothymic disorder who had a first-degree relative with BD I or II and active mood symptoms (Young Mania Rating Scale [YMRS]>11 or Child Depression Rating Scale>29). Participants were randomly allocated to FFT-High Risk version (FFT-HR; 12 sessions of psychoeducation and training in communication and problem-solving skills) or an education control (EC; 1-2 family sessions). RESULTS Youth in FFT-HR had more rapid recovery from their initial mood symptoms (hazard ratio = 2.69, p = .047), more weeks in remission, and a more favorable trajectory of YMRS scores over 1 year than youth in EC. The magnitude of treatment effect was greater among youth in high-EE (versus low-EE) families. CONCLUSIONS FFT-HR may hasten and help sustain recovery from mood symptoms among youth at high risk for BD. Longer follow-up will be necessary to determine whether early family intervention has downstream effects that contribute to the delay or prevention of full manic episodes in vulnerable youth.
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O'Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15:1-44. [PMID: 23237061 DOI: 10.1111/bdi.12025] [Citation(s) in RCA: 540] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first-line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first-line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second-line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not-recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long-acting injection, and adjunctive ziprasidone continue to be first-line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third-line options.
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Affiliation(s)
- Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Correard N, Elissalde SN, Azorin JM, Fakra E, Belzeaux R. [Psychotherapeutic and psychosocial interventions and endophenotypes in bipolar disorders]. Encephale 2013; 38 Suppl 3:S110-5. [PMID: 23279984 DOI: 10.1016/s0013-7006(12)70088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diseases with complex determinism, bipolar disorders, involve at the same time environmental and genetic factors of vulnerability. The characterization of these vulnerabilities would allow a better knowledge of their etiology and envisage the development of therapeutics, more specialized, even preventive. The research in genetic psychiatry allowed to highlight endophenotype candidates associated to bipolar disorders. They are endogenous clinical or biological features, biologically more elementary than phenotypes and more directly bound to the physiological consequences of genes and their polymorphisms. Targeting some of them with specific psychotherapy and psychosocial interventions could reduce the consequences of their expression and so have an action on the course of the disease and also preventive.
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Affiliation(s)
- N Correard
- Pôle Universitaire de Psychiatrie, Hôpital Sainte-Marguerite, Marseille cedex 9, France.
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The sorry state of treatment research in bipolar disorder: an ongoing but preventable catastrophe. J Nerv Ment Dis 2012; 200:924-7. [PMID: 23124174 DOI: 10.1097/nmd.0b013e31827189d4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McNamara RK, Strawn JR, Chang KD, DelBello MP. Interventions for Youth at High Risk for Bipolar Disorder and Schizophrenia. Child Adolesc Psychiatr Clin N Am 2012; 21:739-51. [PMID: 23040899 PMCID: PMC3466439 DOI: 10.1016/j.chc.2012.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Increasing evidence from retrospective and prospective studies is beginning to validate criteria to identify individuals at high risk for developing bipolar disorder or schizophrenia. In parallel, intervention trials are evaluating the efficacy and tolerability of pharmacologic and nonpharmacologic approaches for the treatment of subthreshold and possibly prodromal presentations in these high-risk populations with the ultimate objective of mitigating illness progression. This article reviews current evidence for candidate interventions for high-risk individuals to guide future research in this rapidly emerging field. A clinical vignette describing antidepressant-induced manic symptoms in an adolescent with a family history of bipolar disorder is provided.
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Affiliation(s)
- Robert K. McNamara
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267
| | - Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267
| | - Kiki D. Chang
- Stanford Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Department of Psychiatry, 401 Quarry Road, Stanford, CA 94305, USA
| | - Melissa P. DelBello
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267,To whom correspondence should be addressed: Melissa P. DelBello, MD, MS, Department of Psychiatry, University of Cincinnati College of Medicine, 260 Stetson St. Suite 3200 ML 559, Cincinnati OH 45219, Telephone: (513) 558-4489, Fax: (513) 558-3399,
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Pfennig A, Correll C, Leopold K, Juckel G, Bauer M. Früherkennung und Frühintervention bei bipolaren Störungen. DER NERVENARZT 2012; 83:897-902. [DOI: 10.1007/s00115-012-3589-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Galanter CA, Hundt SR, Goyal P, Le J, Fisher PW. Variability among research diagnostic interview instruments in the application of DSM-IV-TR criteria for pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2012; 51:605-21. [PMID: 22632620 DOI: 10.1016/j.jaac.2012.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 03/13/2012] [Accepted: 03/27/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The DSM-IV-TR criteria for a manic episode and bipolar disorder (BD) were developed for adults but are used for children. The manner in which clinicians and researchers interpret these criteria may have contributed to the increase in BD diagnoses given to youth. Research interviews are designed to improve diagnostic reliability and validity, but vary in how they incorporate DSM-IV-TR criteria for pediatric BD. METHOD We examined DSM-IV-TR criteria and the descriptive text for a manic episode and the mania sections of six commonly used pediatric diagnostic research interviews focusing on the following: interpretation of DSM-IV-TR, recommendations for administration, and scoring methods. RESULTS There are differences between the DSM-IV-TR manic episode criteria and descriptive text. Instruments vary in several ways including in their conceptualization of the mood criterion, whether symptoms must represent a change from the child's usual state, and whether B-criteria are required to co-occur with the A-criterion. Instruments also differ on recommendations for administration and scoring methods. CONCLUSIONS Given the differences between DSM-IV-TR manic episode criteria and explanatory text, it is not surprising that there is considerable variation between diagnostic instruments based on DSM-IV-TR. These differences likely lead to dissimilarities in subjects included in BD research studies and inconsistent findings across studies. The field of child psychiatry would benefit from more uniform methods of assessing symptoms and determining pediatric BD diagnoses. We discuss recommendations for changes to future instruments, interviews, assessment, and the DSM-5.
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Affiliation(s)
- Cathryn A Galanter
- State University of New York Downstate and the Kings County Hospital Center, 451 Clarkson Avenue, Brooklyn, NY 11203, USA.
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Strober M, Johnson C. The need for complex ideas in anorexia nervosa: why biology, environment, and psyche all matter, why therapists make mistakes, and why clinical benchmarks are needed for managing weight correction. Int J Eat Disord 2012; 45:155-78. [PMID: 22287383 DOI: 10.1002/eat.22005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2012] [Indexed: 11/12/2022]
Abstract
Anorexia nervosa remains an enigma and its clinical challenge is intimidating. But the potential for new insights has been advancing, largely as a result of elegant research in the neurosciences that has modeled behavioral processes resembling key features of the illness. Unfortunately, many in the eating disorder field seem to know little of this work or the implication it holds for treatment philosophy. Instead, the knowledge void has been taken up recently by a host of misguided notions about etiology, blatantly dismissive attitudes toward psychological concepts, and ill-conceived beliefs about therapy priorities. This article is a clinical perspective on these issues.
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Affiliation(s)
- Michael Strober
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Miklowitz DJ. Family-focused treatment for children and adolescents with bipolar disorder. THE ISRAEL JOURNAL OF PSYCHIATRY AND RELATED SCIENCES 2012; 49:95-101. [PMID: 22801288 PMCID: PMC3869947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The course of bipolar disorder in children and adolescents is highly recurrent and impairing. This article describes the adaptation of family-focused treatment (FFT) for children and adolescents with bipolar disorder. FFT is given in 21 sessions over 9 months, and is usually initiated during the recovery period following an acute episode of depression or (hypo)mania. The treatment consists of an engagement phase followed by psychoeducation, communication enhancement training, and problem-solving skills training. Results of randomized trials in adults and adolescents find that patients with bipolar disorder who receive FFT and pharmacotherapy recover from episodes more quickly and have longer periods of sustained remission than patients who receive briefer forms of therapy and pharmacotherapy. The application of FFT to youth who are genetically at risk for bipolar disorder is described. Problems in disseminating empirically supported family interventions in community settings are discussed.
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Affiliation(s)
- David J Miklowitz
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles Semel Institute for Neuroscience and Behavior, California, U.S.A
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Do we really know how to treat a child with bipolar disorder or one with severe mood dysregulation? Is there a magic bullet? DEPRESSION RESEARCH AND TREATMENT 2012; 2012:967302. [PMID: 22203894 PMCID: PMC3235717 DOI: 10.1155/2012/967302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 09/22/2011] [Accepted: 10/25/2011] [Indexed: 11/17/2022]
Abstract
Background. Despite controversy, bipolar disorder (BD) is being increasingly diagnosed in under 18s. There is scant information regarding its treatment and uncertainty regarding the status of "severe mood dysregulation (SMD)" and how it overlaps with BD. This article collates available research on treatment of BD in under 18s and explores the status of SMD. Methods. Literature on treatment of BD in under 18s and on SMD were identified using major search engines; these were then collated and reviewed. Results. Some markers have been proposed to differentiate BD from disruptive behaviour disorders (DBD) in children. Pharmacotherapy restricted to short-term trials of mood-stabilizers and atypical-antipsychotics show mixed results. Data on maintenance treatment and non-pharmacological interventions are scant. It is unclear whether SMD is an independent disorder or an early manifestation of another disorder. Conclusions. Valproate, lithium, risperidone, olanzapine, aripiprazole and quetiapine remain first line treatments for acute episodes in the under 18s with BD. Their efficacy in maintenance treatment remains unclear. There is no validated treatment for SMD. It is likely that some children who are currently diagnosed with BD and DBD and possibly most children currently diagnosed with SMD will be subsumed under the proposed category in the DSM V of disruptive mood dysregulation disorder with dysphoria.
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Early detection and intervention in bipolar affective disorder: targeting the development of the disorder. Curr Psychiatry Rep 2011; 13:493-9. [PMID: 21850462 PMCID: PMC3836252 DOI: 10.1007/s11920-011-0229-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The diagnosis of bipolar affective disorder (BD) is often delayed, and preceded by incorrect diagnoses and potentially harmful treatment, while the development of the disorder is associated with suicidal behavior and help seeking. Several clinical features have been linked to an increased risk of going on to develop BD, in particular attenuated symptoms of BD, personality traits such as cyclothymia, and general psychopathologic symptoms. Several of these show high specificity, indicating that it may be possible to target detection and intervention in individuals at high risk of BD and perhaps moderate the course of the illness and improve treatment outcome. This article summarizes recent evidence on the characteristics of the prodrome to BD and discusses the potential value and challenges of early detection and intervention in BD.
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Abstract
The longitudinal course of bipolar disorder (BD) is highly impairing. This article reviews recent research on functional impairment in the course of BD, the roles of social and intrafamilial stress in relapse and recovery, and the role of adjunctive psychosocial interventions in reducing risk and enhancing functioning. Comparative findings in adult and childhood BD are highlighted. Life events and family-expressed emotion have emerged as significant predictors of the course of BD. Studies of social information processing suggest that impairments in the recognition of facial emotions may characterize both adult- and early-onset bipolar patients. Newly developed psychosocial interventions, particularly those that focus on family and social relationships, are associated with more rapid recovery from episodes and better psychosocial functioning. Family-based psychoeducational approaches are promising as early interventions for children with BD or children at risk of developing the disorder. For adults, interpersonal therapy, mindfulness-based strategies, and cognitive remediation may offer promise in enhancing functioning.
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Affiliation(s)
- David J Miklowitz
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Behavior, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Room 58-217, Los Angeles, CA 90024-1759, USA.
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63
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Current world literature. Curr Opin Pediatr 2011; 23:700-7. [PMID: 22068136 DOI: 10.1097/mop.0b013e32834dda34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Taylor M, Bressan RA, Pan PM, Brietzke E. Early intervention for bipolar disorder: current imperatives, future directions. BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 33 Suppl 2:s197-212. [DOI: 10.1590/s1516-44462011000600006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES: The objective of this article is to discuss the rationale/background for early intervention in bipolar disorder. METHOD: Narrative review. RESULTS: There are often significant delays before the diagnosis of bipolar disorder is made and effective management initiated. Growing evidence from both preclinical and clinical literature points to a clear need for improved early identification and early intervention in bipolar disorder. Increasing efforts are being applied to the identification of those at high risk of onset of bipolar disorder. It is hoped that identification of an early prodrome of illness will allow preventative measures to be taken. CONCLUSIONS: There is a clear rationale for improved early identification and early intervention in bipolar disorder.
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Affiliation(s)
| | | | | | - Elisa Brietzke
- Universidade Federal de São Paulo, Brazil; Universidade Federal de São Paulo, Brazil
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