1
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Danielyan A, Patino LR, Benanzer T, Blom TJ, Welge JA, Chang KD, Adler CM, DelBello MP. Cognitive, Family, and Quality-of-Life Characteristics of Youth with Depression Associated with Bipolar Disorder. J Child Adolesc Psychopharmacol 2023; 33:225-231. [PMID: 37590017 PMCID: PMC10458366 DOI: 10.1089/cap.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background: Depression associated with bipolar disorder (BD) is more common compared to mania. Cognitive, family, and quality-of-life (QOL) factors associated with pediatric bipolar depression are understudied. The goal of this study was to evaluate cognitive, family environmental, and QOL characteristics of youth with bipolar depression. Methods: Thirty-two youth (12-18 years of age) with BD type I currently depressed were recruited from inpatient and outpatient setting. Subjects were assessed using the Behavior Rating Inventory of Executive Function (BRIEF), the Family Environment Scale (FES), and the Child Health Questionnaire-Parental-Form 50 (CHQ-PF50). Results were compared with population norms and the relationship between these domains was calculated. Results: Youth with depression associated with BD did not show significant impairment in executive functions. They displayed impaired family environment in the domains of cohesion, independence, achievement orientation, and organization. Youth also displayed impairments in the psychosocial health domains compared with the population normative data. The CHQ-Psychosocial health significantly negatively correlated with the BRIEF-Global Executive Control score (r = -0.76, p < 0.0001). Conclusion: Depression in youth with BD is associated with impairments in family functioning and QOL. Impairments in psychosocial QOL are associated with cognitive functioning. Further intervention studies examining executive functioning and family environment as treatment targets are needed. ClinicalTrials.gov identifier:NCT00232414.
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Affiliation(s)
- Arman Danielyan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Luis R. Patino
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Tessa Benanzer
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Thomas J. Blom
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey A. Welge
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Kiki D. Chang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Caleb M. Adler
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Melissa P. DelBello
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
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2
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Social and environmental variables as predictors of mania: a review of longitudinal research findings. DISCOVER MENTAL HEALTH 2022; 2:7. [PMID: 35310132 PMCID: PMC8918447 DOI: 10.1007/s44192-022-00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/07/2022] [Indexed: 10/31/2022]
Abstract
AbstractConsiderable evidence suggests that psychosocial variables can shape the course of bipolar disorder. Here, though, we focus on the more specific idea that the social environment can predict the course of mania. We systematically review evidence from longitudinal studies concerning how social support, family interactions, traumatic life events, and recent life events relate to the age of onset, the frequency of episode recurrence, and the severity of manic symptoms. Although we find some evidence that the course of mania can be worsened by social environmental factors, the links are specific. Among social variables, some studies indicate that conflict and hostility are predictive, but more general social relationship qualities have not been found to predict mania. Some research indicates that childhood trauma, and recent life events involving goal attainment or sleep disruption can predict mania. Taken together, the profile of variables involving recent exposure that are most predictive include those that are activating, reward-related, or sleep-disrupting, which fits with general psychological hypotheses of behavioral activation and sleep disruption as important for mania. We discuss gaps in the literature, and we note future directions for research, including the need for more integrative, longitudinal research on a fuller range of social and biological risk variables.
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3
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Ni H, Lin Y, Peng Y, Li S, Huang X, Chen L. Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model. Front Pharmacol 2022; 13:817406. [PMID: 35273498 PMCID: PMC8902640 DOI: 10.3389/fphar.2022.817406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms. Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy. Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes's PROCESS macro, based on the bootstrapping method. Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = -0.36, 95% CI: (-0.50, -0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β = 0.36, 95% CI: (0.23, 0.50)]. Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.
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Affiliation(s)
- Hong Ni
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yanjuan Lin
- Department of Nursing, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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4
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Brickman HM, Fristad MA. Psychosocial Treatments for Bipolar Disorder in Children and Adolescents. Annu Rev Clin Psychol 2022; 18:291-327. [PMID: 35216522 DOI: 10.1146/annurev-clinpsy-072220-021237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence suggests that adjunctive psychosocial intervention for the treatment of pediatric bipolar spectrum disorders (BPSDs) is effective, feasible, and highly accepted as both an acute and maintenance treatment for youth with BPSD diagnoses as well as a preventive treatment for high-risk youth who are either asymptomatic or exhibit subsyndromal mood symptoms. Here, we provide a comprehensive review of all known evidence-based interventions, including detailed descriptions of treatment targets and core components, results of clinical trials, and updated research on mediators and moderators of treatment efficacy. Treatments are presented systematically according to level of empirical support (i.e., well established, probably efficacious, possibly efficacious, experimental, or questionable); upcoming and ongoing trials are included when possible. In line with a staging approach, preventive interventions are presented separately. Recommendations for best practices based on age, stage, and additional evidence-based child and family factors shown to affect treatment outcomes are provided. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Haley M Brickman
- Big Lots Behavioral Health Services and Division of Child and Family Psychiatry, Nationwide Children's Hospital, Columbus, Ohio; ,
| | - Mary A Fristad
- Big Lots Behavioral Health Services and Division of Child and Family Psychiatry, Nationwide Children's Hospital, Columbus, Ohio; ,
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5
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Dou W, Yu X, Fang H, Lu D, Cai L, Zhu C, Zong K, Zheng Y, Lin X. Family and Psychosocial Functioning in Bipolar Disorder: The Mediating Effects of Social Support, Resilience and Suicidal Ideation. Front Psychol 2022; 12:807546. [PMID: 35153929 PMCID: PMC8832135 DOI: 10.3389/fpsyg.2021.807546] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/27/2021] [Indexed: 01/15/2023] Open
Abstract
Patients with bipolar disorder (BD) may experience family dysfunction, which might result in worse psychosocial functioning through environmental and psychological factors. Research investigating the mediating role of social support, resilience and suicidal ideation on family and psychosocial functioning in BD is rare. The study aims to explore the predicting and mediating effects of social support, resilience and suicidal ideation on family and psychosocial functioning in BD patients. Two hundred forty-six patients with BD and sixty-nine healthy controls were recruited. The Family Assessment Device (FAD), Functioning Assessment Short Test (FAST), Social Support Rating Scale (SSRS), Connor-Davidson Resilience Scale (CD-RISC) and Beck Scale for Suicide Ideation (BSI) were used to assess family functioning, psychosocial functioning, social support, resilience and suicidal ideation, respectively. Bipolar patients exhibited worse family and psychosocial functioning than healthy controls. Family functioning, social support, resilience and suicidal ideation significantly predict psychosocial functioning in the bipolar group. Social support, resilience and suicidal ideation indirectly mediate the effect of family functioning on psychosocial functioning in bipolar patients. Cross-sectional design and mixed sample including acute and remitted stages. Treatments for patients with bipolar disorder should be combined with family strategies that are formulated to improve psychosocial functioning. An emphasis should be placed on enhancing social support and resilience while paying attention to suicidal ideation.
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Affiliation(s)
- Wenbo Dou
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xueying Yu
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hengying Fang
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dali Lu
- Xiamen Xianyue Hospital, Xiamen, China
| | - Lirong Cai
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Caihong Zhu
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kunlun Zong
- Guangzhou Brain Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yingjun Zheng
- Guangzhou Brain Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoling Lin
- School of Nursing, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiaoling Lin,
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6
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Birmaher B, Merranko J, Hafeman D, Goldstein BI, Diler R, Levenson JC, Monk K, Iyengar S, Hickey MB, Sakolsky D, Axelson D, Goldstein T. A Longitudinal Study of Psychiatric Disorders in Offspring of Parents With Bipolar Disorder From Preschool to Adolescence. J Am Acad Child Adolesc Psychiatry 2021; 60:1419-1429. [PMID: 33785405 PMCID: PMC8473582 DOI: 10.1016/j.jaac.2021.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/25/2021] [Accepted: 02/19/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To compare the prevalence of psychopathology, particularly bipolar disorder (BD), between preschool offspring of parents with BD and community controls. METHOD A total of 116 offspring of BD-I/II parents and 98 controls (53 parents with non-BD psychopathology and 45 healthy parents) were recruited at ages 2 to 5 years and followed on average 9.6 years (on average: 2-5: 1.6 times; after age 5: 4 times) (average ages at intake/last follow-up: 3.8/13.4, retention: 98%). Participants were evaluated with standardized instruments blinded to parental diagnoses. RESULTS After adjusting for confounders, offspring of BD parents only showed more attention-deficit/hyperactivity disorder (ADHD) during ages 2 to 5 years than the other 2 groups. After age 5, offspring of BD parents did not differ from offspring of parents with non-BD psychopathology, but they had more anxiety, ADHD, and behavior problems than offspring of healthy parents. Only offspring of BD parents developed BD-I/II: 3.4% (n = 4) and BD-not-otherwise-specified (BD-NOS): 11.2% (n = 13), with mean onset ages 11.4 and 7.4, respectively. About 70% of offspring with BD had non-BD disorders before BD. Only ADHD, diagnosed before age 6 years, and early-onset parental BD were significantly associated with BD risk. CONCLUSION Most offspring of BD parents did not develop BD, but they were at specific high risk for developing BD, particularly those with preschool ADHD and early-onset parental BD. BD symptoms were scarce during the preschool years and increased throughout the school age, mainly in the form of BD-NOS, a disorder that conveys poor prognosis and high risk to develop BD-I/II. Developing early interventions to delay or, ideally, to prevent its onset are warranted.
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Affiliation(s)
- Boris Birmaher
- Drs. Birmaher, Hafeman, Diler, Levenson, Sakolsky, Goldstein, Mr. Merranko, and Mss. Monk and Hickey are with Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania.
| | - John Merranko
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Danella Hafeman
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Benjamin I. Goldstein
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Rasim Diler
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Jessica C. Levenson
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Kelly Monk
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | | | - Mary Beth Hickey
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - Dara Sakolsky
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania
| | - David Axelson
- Nationwide Children’s Hospital and The Ohio State College of Medicine, Columbus
| | - Tina Goldstein
- Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pennsylvania.; Center for Addiction and Mental Health, University of Toronto Faculty of Medicine, Ontario, Canada
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7
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MacPherson HA, Kudinova AY, Jenkins GA, Kim KL, Radoeva PD, Gilbert AC, Barthelemy C, DeYoung L, Yen S, Hower H, Hunt J, Keller MB, Dickstein DP. Facial emotion recognition and mood symptom course in young adults with childhood-onset bipolar disorder. Eur Arch Psychiatry Clin Neurosci 2021; 271:1393-1404. [PMID: 33744993 PMCID: PMC8528564 DOI: 10.1007/s00406-021-01252-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Facial emotion recognition deficits are common in bipolar disorder (BD) and associated with impairment. However, the relationship between facial emotion recognition and mood course is not well understood. This study examined facial emotion recognition and subsequent mood symptoms in young adults with childhood-onset BD versus typically developing controls (TDCs). The sample included 116 young adults (ages 18-30, 58% male, 78% White) with prospectively verified childhood-onset BD (n = 52) and TDCs (n = 64). At baseline, participants completed a facial emotion recognition task (Diagnostic Analysis of Non-Verbal Accuracy-2) and clinical measures. Then, participants with BD completed mood symptom assessments every 6 months (M = 8.7 ± 5.2 months) over two years. Analyses included independent-samples t tests and mixed-effects regression models. Participants with BD made significantly more recognition errors for child expressions than TDCs. There were no significant between-group differences for recognition errors for adult expressions, or errors for specific child or adult emotional expressions. Participants had moderate baseline mood symptoms. Significant time-by-facial emotion recognition interactions revealed more recognition errors for child emotional expressions predicted lower baseline mania and stable/consistent trajectory; fewer recognition errors for child expressions predicted higher baseline mania and decreasing trajectory. In addition, more recognition errors for adult sad expressions predicted stable/consistent depression trajectory and decreasing mania; fewer recognition errors for adult sad expressions predicted decreasing depression trajectory and stable/consistent mania. Effects remained when controlling for baseline demographics and clinical variables. Facial emotion recognition may be an important brain/behavior mechanism, prognostic indicator, and intervention target for childhood-onset BD, which endures into young adulthood and is associated with mood trajectory.
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Affiliation(s)
- Heather A. MacPherson
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Anastacia Y. Kudinova
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gracie A. Jenkins
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Kerri L. Kim
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Petya D. Radoeva
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Anna C. Gilbert
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Christine Barthelemy
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Lena DeYoung
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA,Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA,Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA,Department of Psychiatry, School of Medicine, University of California at San Diego, San Diego, CA, USA
| | - Jeffrey Hunt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel P. Dickstein
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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8
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Salem T, Walters KA, Verducci JS, Fristad MA. Psychoeducational and Skill-building Interventions for Emotion Dysregulation. Child Adolesc Psychiatr Clin N Am 2021; 30:611-622. [PMID: 34053689 DOI: 10.1016/j.chc.2021.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Family psychoeducation plus skill building is a class of interventions considered to be well-established for youth with mood disorders or emotion dysregulation. Psychoeducational psychotherapy (PEP) is an example of this class of interventions. PEP provides psychoeducation for parents and children, skill building to help children better regulate emotions and behaviors, and strategies for parents to better facilitate school-based interventions, develop specific symptom management techniques, and generate coping strategies for the entire family. Evidence is summarized supporting the efficacy of PEP for reducing rage, overall mood symptom severity, disruptive behavior, and executive functioning deficits in youth. Long-term benefits of PEP are discussed.
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Affiliation(s)
- Taban Salem
- Department of Psychology and Neuroscience, Millsaps College, 1701 North State Street, Jackson, MS 39210, USA
| | - Kimberly A Walters
- Statistics Collaborative, Inc., 1625 Massachusetts Avenue NQ, Suite 600, Washington, DC 20036, USA
| | - Joseph S Verducci
- Department of Statistics, The Ohio State University, 404 Cockins Hall, 1458 Neil Avenue, Columbus, OH 43210, USA
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Harding Hospital, Suite 460H, 1670 Upham Drive, Columbus, OH 43210, USA; Nationwide Children's Hospital Behavioral Health Pavilion, 444 Butterfly Gardens Drive #3207, Columbus, OH 43215, USA.
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9
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MacPherson HA, Wolff J, Nestor B, Frazier E, Massing-Schaffer M, Graves H, Esposito-Smythers C, Spirito A. Parental Monitoring Predicts Depressive Symptom and Suicidal Ideation Outcomes in Adolescents Being Treated for Co-Occurring Substance Use and Psychiatric Disorders. J Affect Disord 2021; 284:190-198. [PMID: 33607509 PMCID: PMC7926270 DOI: 10.1016/j.jad.2021.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Comorbidity of substance use disorders (SUDs) with mood disorders and other psychiatric conditions is common. Parenting processes and family functioning are impaired in adolescents with SUDs and mood disorders, and parent/family factors predict intervention response. However, limited research has examined the relationship between parent/family factors and mood symptom treatment response in adolescents with comorbid SUDs and psychiatric conditions. METHOD This study examined the predictive effects of parenting processes and family functioning on depressive symptoms and suicidal ideation (SI) in a randomized controlled trial of integrated cognitive-behavioral therapy vs. treatment as usual for 111 adolescents with comorbid SUDs and psychiatric disorders. Measures of parenting processes, family functioning, depressive symptoms, and SI were completed at baseline and 3-, 6-, and 12-month follow-ups. Exploratory analyses involved mixed-effects regression models. RESULTS Across treatment conditions, depressive symptoms and SI improved over 12 months. Family functioning domains of family roles (d=0.47) and affective involvement (d=0.39) significantly improved across treatment conditions over 12 months. Higher baseline parental monitoring predicted improved trajectory of depressive symptoms (d=0.44) and SI (d=0.46). There were no significant predictive effects for baseline family functioning or other parenting processes (listening, limit setting). LIMITATIONS Limitations include the modest sample, attrition over follow-up, and generalizability to samples with higher rates of mood disorders and/or uncomplicated mood disorders. CONCLUSIONS Parental monitoring may be an important prognostic indicator of depressive symptoms and SI in adolescents with co-occurring SUDs and psychiatric conditions, and therefore may be useful to assess and target in treatment, in addition to family functioning.
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Affiliation(s)
- Heather A. MacPherson
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Emma Pendleton Bradley Hospital, East Providence, RI,
USA,Corresponding Author: Heather A. MacPherson, 1011
Veterans Memorial Parkway, East Providence, RI 02915, Phone: (401) 432-1162,
Fax: (401) 432-1607,
| | - Jennifer Wolff
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA
| | - Bridget Nestor
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | - Elisabeth Frazier
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Emma Pendleton Bradley Hospital, East Providence, RI,
USA
| | - Maya Massing-Schaffer
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | - Hannah Graves
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
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10
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Cirone C, Secci I, Favole I, Ricci F, Amianto F, Davico C, Vitiello B. What Do We Know about the Long-Term Course of Early Onset Bipolar Disorder? A Review of the Current Evidence. Brain Sci 2021; 11:brainsci11030341. [PMID: 33800274 PMCID: PMC8001096 DOI: 10.3390/brainsci11030341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: Early onset of psychopathology is often an index of a more severe clinical course and worse prognosis. This review examined the course of bipolar disorder (BD) with onset in childhood and adolescence, with a focus on persistence of symptoms, severity of illness, comorbidity, and functional impairment. Methods: The databases of PubMed, Embase, and PsycInfo were systematically searched for publications since 1990 reporting on long-term (12 months or longer) assessments of patients with early onset BD. Results: Forty-two relevant publications were identified, which reported on data derived from 15 different patient cohorts, including 7 prospective research psychopathology studies, 4 medical record reviews, 2 follow-ups of clinical trial samples, 1 managed care database, and 1 nationwide registry, for a total of 10,187 patients. The length of follow-ups ranged from 1.0 to 15 years. Diagnostic stability of BD ranged from 73% to 100% over ten years. Recovery rate from an index episode was 81.5–100% and recurrence rate was 35–67%. Suicide attempt cumulative prevalence in five years was 18–20%. Earlier age at the first episode predicted a more severe clinical course. Conclusions: Early onset BD persists over time through adolescence, with homotypic diagnostic continuity over the years, but heterogeneity in the severity of the clinical course. Whether early identification and treatment improves distal prognosis remains to be further investigated.
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Affiliation(s)
- Carlotta Cirone
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
| | - Ilaria Secci
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
| | - Irene Favole
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
| | - Federica Ricci
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
| | - Federico Amianto
- Child and Adolescent Neuropsychiatry—Department of Neurosciences, Universita’ degli Studi di Torino, 10126 Turin, Italy;
| | - Chiara Davico
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
- Correspondence:
| | - Benedetto Vitiello
- Child and Adolescent Neuropsychiatry—Department of Public Health and Pediatric Sciences, Universita’ degli Studi di Torino, 10126 Turin, Italy; (C.C.); (I.S.); (I.F.); (F.R.); (B.V.)
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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11
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Effects of family-focused therapy on suicidal ideation and behavior in youth at high risk for bipolar disorder. J Affect Disord 2020; 275:14-22. [PMID: 32658817 PMCID: PMC7395856 DOI: 10.1016/j.jad.2020.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Youth who are at clinical and familial risk for bipolar disorder (BD) often have significant suicidal ideation (SI). In a randomized trial, we examined whether family-focused therapy (FFT) is associated with reductions in SI and suicidal behaviors in high-risk youth. METHODS Participants (ages 9-17 years) met diagnostic criteria for unspecified BD or major depressive disorder with active mood symptoms and had at least one relative with BD type I or II. Participants were randomly allocated to 12 sessions in 4 months of FFT or 6 sessions in 4 months of psychoeducation (enhanced care, EC), with pharmacotherapy as needed. Clinician- and child-rated assessments of mood, suicidal thoughts and behaviors, and family conflict were obtained at baseline and 4-6 month intervals over 1-4 years. RESULTS Participants (N=127; mean 13.2±2.6 yrs., 82 female) were followed over an average of 105.9±64.0 weeks. Youth with high baseline levels of SI who received FFT had lower levels of (and fewer weeks with) SI at follow-up compared to youth with high baseline SI who received EC. Participants in FFT had longer intervals without suicidal behaviors than participants in EC. Youths' ratings of family conflict significantly mediated the effects of treatment on SI at follow-up. LIMITATIONS Family conflict was based on questionnaires rather than observer ratings of family interactions. CONCLUSIONS Family psychoeducation with skill training can be an effective deterrent to suicidal thoughts and behaviors in youth at high risk for BD. Reducing parent/offspring conflict should be a central objective of psychosocial interventions for high-risk youth with SI.
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O'Donnell LA, Weintraub MJ, Ellis AJ, Axelson DA, Kowatch RA, Schneck CD, Miklowitz DJ. A Randomized Comparison of Two Psychosocial Interventions on Family Functioning in Adolescents with Bipolar Disorder. FAMILY PROCESS 2020; 59:376-389. [PMID: 32012257 PMCID: PMC7282964 DOI: 10.1111/famp.12521] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Impairments in family functioning are associated with more severe depressive and manic symptoms, earlier recurrences, and more suicidal behaviors in early-onset bipolar disorder. This study examined whether family-focused treatment for adolescents (FFT-A) with BD I or II disorder led to greater increases in family cohesion and adaptability and decreases in conflict over 2 years compared to a briefer psychoeducational treatment (enhanced care, EC). Participants were 144 adolescents (mean age: 15.6 ± 1.4 years) with BD I or II with a mood episode in the previous 3 months. Adolescents and parents were randomized to either FFT-A (21 sessions) or EC (three sessions). Patients received guideline-based pharmacotherapy throughout the 2-year study. Trajectories of adolescent- and parent-rated family cohesion, adaptability, and conflict were analyzed over 2 years. FFT-A had greater effects on adolescent-rated family cohesion compared to EC over 2 years. Participants in FFT-A and EC reported similar improvements in family conflict across the 2 years. In the FFT-A group, low-conflict families had greater adolescent-rated family cohesion throughout the study compared to high-conflict families. High-conflict families in both treatment groups tended to show larger reductions in conflict over 2 years than low-conflict families. Family psychoeducation and skills training may improve family cohesion in the early stages of BD. Measuring levels of family conflict at the start of treatment may inform treatment responsiveness among those receiving FFT-A.
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Affiliation(s)
| | - Marc J Weintraub
- Department of Psychiatry, Semel Institute, University of California, Los Angeles, Los Angeles, CA
| | - Alissa J Ellis
- Department of Psychiatry, Semel Institute, University of California, Los Angeles, Los Angeles, CA
| | | | | | | | - David J Miklowitz
- Department of Psychiatry, Semel Institute, University of California, Los Angeles, Los Angeles, CA
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Miklowitz DJ, Schneck CD, Walshaw PD, Singh MK, Sullivan AE, Suddath RL, Forgey Borlik M, Sugar CA, Chang KD. Effects of Family-Focused Therapy vs Enhanced Usual Care for Symptomatic Youths at High Risk for Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:455-463. [PMID: 31940011 PMCID: PMC6990706 DOI: 10.1001/jamapsychiatry.2019.4520] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Behavioral high-risk phenotypes predict the onset of bipolar disorder among youths who have parents with bipolar disorder. Few studies have examined whether early intervention delays new mood episodes in high-risk youths. OBJECTIVE To determine whether family-focused therapy (FFT) for high-risk youths is more effective than standard psychoeducation in hastening recovery and delaying emergence of mood episodes during the 1 to 4 years after an active period of mood symptoms. DESIGN, SETTINGS, AND PARTICIPANTS This multisite randomized clinical trial included referred youths (aged 9-17 years) with major depressive disorder or unspecified (subthreshold) bipolar disorder, active mood symptoms, and at least 1 first- or second-degree relative with bipolar disorder I or II. Recruitment started from October 6, 2011, and ended on September 15, 2016. Independent evaluators interviewed participants every 4 to 6 months to measure symptoms for up to 4 years. Data analysis was performed from March 13 to November 3, 2019. INTERVENTIONS High-risk youths and parents were randomly allocated to FFT (12 sessions in 4 months of psychoeducation, communication training, and problem-solving skills training; n = 61) or enhanced care (6 sessions in 4 months of family and individual psychoeducation; n = 66). Youths could receive medication management in either condition. MAIN OUTCOMES AND MEASURES The coprimary outcomes, derived using weekly psychiatric status ratings, were time to recovery from prerandomization symptoms and time to a prospectively observed mood (depressive, manic, or hypomanic) episode after recovery. Secondary outcomes were time to conversion to bipolar disorder I or II and longitudinal symptom trajectories. RESULTS All 127 participants (82 [64.6%] female; mean [SD] age, 13.2 [2.6] years) were followed up for a median of 98 weeks (range, 0-255 weeks). No differences were detected between treatments in time to recovery from pretreatment symptoms. High-risk youths in the FFT group had longer intervals from recovery to the emergence of the next mood episode (χ2 = 5.44; P = .02; hazard ratio, 0.55; 95% CI, 0.48-0.92;), and from randomization to the next mood episode (χ2 = 4.44; P = .03; hazard ratio, 0.59; 95% CI, 0.35-0.97) than youths in enhanced care. Specifically, FFT was associated with longer intervals to depressive episodes (log-rank χ2 = 6.24; P = .01; hazard ratio, 0.53; 95% CI, 0.31-0.88) but did not differ from enhanced care in time to manic or hypomanic episodes, conversions to bipolar disorder, or symptom trajectories. CONCLUSIONS AND RELEVANCE Family skills-training for youths at high risk for bipolar disorder is associated with longer times between mood episodes. Clarifying the relationship between changes in family functioning and changes in the course of high-risk syndromes merits future investigation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01483391.
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Affiliation(s)
- David J. Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles
| | | | - Patricia D. Walshaw
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles
| | - Manpreet K. Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Aimee E. Sullivan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver
| | - Robert L. Suddath
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles
| | - Marcy Forgey Borlik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles
| | - Catherine A. Sugar
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles,Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles
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Smyth K, Salloum A, Herring J. Interpersonal functioning, support, and change in early-onset bipolar disorder: a transcendental phenomenological study of emerging adults. J Ment Health 2020; 30:121-128. [PMID: 31997686 DOI: 10.1080/09638237.2020.1713997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Early-onset bipolar disorder (EOBD) diagnoses have increased, yet much remains to be understood about its phenomenology. Research and treatment models developed for adult-onset bipolar disorder have largely overlooked qualitative inquiries and adolescent developmental considerations that influence course of illness. AIM The purpose of the current study was to obtain an understanding of the lived experience of interpersonal relationships and EOBD during adolescence through the retrospective report of emerging adults. METHODS This study utilized a transcendental phenomenological design. A purposive sample of eight participants ages 18-25 participated in semi-structured interviews that explored the experience of interpersonal relationships and EOBD throughout adolescence. RESULTS Participants described their experiences across three broad themes: managing and coping with EOBD; effect of EOBD on relationships; and change and uncertainty. Sub-themes include knowledge and denial of illness, involvement of others in treatment, support, difficulty maintaining social functioning, isolation and secrecy, and changes in relationships. CONCLUSIONS Participants characterized adolescence as a period of constant, simultaneous challenges in symptom management, maintaining social functioning, and concurrent changes in family and peer relationships that provide interpersonal support. Future qualitative studies should explore the implications of normative social development and family functioning for the course of illness and treatment outcomes.
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Affiliation(s)
- Kristin Smyth
- Department of Social Work, Western Carolina University, Cullowhee, NC, USA
| | - Alison Salloum
- Department of Social Work, University of South Florida, Tampa, FL, USA
| | - Jaclyn Herring
- Department of Social Work, Western Carolina University, Cullowhee, NC, USA
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Peris TS, Rozenman M, Gonzalez A, Vreeland A, Piacentini J, Tan PZ, Ricketts EJ. Family functioning in pediatric trichotillomania, obsessive compulsive disorder, and healthy comparison youth. Psychiatry Res 2019; 281:112578. [PMID: 31586836 DOI: 10.1016/j.psychres.2019.112578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
Pediatric trichotillomania (TTM) is an understudied condition that can be highly impairing; little is known about family environmental features that shape its development and course. We examined family functioning among age and gender-matched groups of youth with primary TTM (n = 30; mean age = 12.87), obsessive compulsive disorder (OCD; n = 30; mean age = 12.70), and no psychiatric history (healthy controls; HC; n = 30; mean age = 12.46). An additional group of n = 25 TTM cases was employed to examine relationships between TTM severity and family functioning. All youth completed standardized diagnostic assessment, including the Family Environment Scale (FES) and Children's Report of Parenting Behavior Inventory (CRPBI). Family functioning was more impaired among both TTM and OCD cases relative to controls, as evidenced by higher levels of child-reported FES conflict and lower cohesion, expressiveness, and organization. Less consistent findings emerged on parent report, with cohesion, but not conflict, distinguishing the HC and clinical groups. In keeping with prior research, parents of TTM-affected youth also reported lower expressiveness and cohesion than parents in the OCD group. There was limited evidence for links between hair-pulling severity and family impairment and no links to parenting behavior. Findings are discussed in terms of implications for family focused treatment.
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Affiliation(s)
- Tara S Peris
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States.
| | | | - Araceli Gonzalez
- California State University Long Beach, Long Beach, CA 90840, United States
| | | | - John Piacentini
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States
| | - Patricia Z Tan
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States
| | - Emily J Ricketts
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, United States
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16
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Zhang X, Zhao M, Li J, Shi L, Xu X, Dai Q, Zhang Y, Liu H, Liu W, Zhang X, Li K, Shi Z, Lin CY. Associations between family cohesion, adaptability, and functioning of patients with bipolar disorder with clinical syndromes in Hebei, China. J Int Med Res 2019; 47:6004-6015. [PMID: 31631724 PMCID: PMC7045660 DOI: 10.1177/0300060519877030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to investigate the symptoms of inpatients with bipolar disorder (BD) in different types of families, and to explore the correlations between family coherence, family adaptability, and family functioning among inpatients with BD. Methods Inpatients with BD in Hebei, China (n = 61; mean age = 33.85±10.54; 39 males) participated in this study. Participants’ symptoms were evaluated using the Bech–Rafaelsen Mania Scale (BRMS) and Hamilton Depression Rating Scale (HDRS) at weeks 1, 4, and 8 after their admission to the hospital. Participants’ family type was assessed using the Family Adaptability and Cohesion Scale II–Chinese Version. Family functioning was assessed using Family Assessment Device. Results Participants were classified into three family types: balanced (n = 13), mid-range (n = 28), and extreme (n = 20). BRMS scores improved over time in patients from all three family types. Improvement was slightly better with the balanced than the extreme family type. HDRS scores showed an improving trend over time, although this was not significant. Family coherence, adaptability, and functioning were mutually correlated. Conclusion The family system and family functioning are important factors that clinicians should keep in mind when treating people with BD.
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Affiliation(s)
| | | | - Jing Li
- Hebei Mental Health Center, Hebei, China
| | - Ling Shi
- Hebei Mental Health Center, Hebei, China
| | - Xiafei Xu
- Hebei Mental Health Center, Hebei, China
| | - Qian Dai
- Hebei Mental Health Center, Hebei, China
| | | | - Huilan Liu
- Hebei Mental Health Center, Hebei, China
| | - Wei Liu
- Hebei Mental Health Center, Hebei, China
| | | | - Keqing Li
- Hebei Mental Health Center, Hebei, China
| | - Zhanbiao Shi
- Institute of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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17
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Shalev A, Merranko J, Goldstein T, Miklowitz DJ, Axelson D, Goldstein BI, Brent D, Monk K, Hickey MB, Hafeman DM, Sakolsky D, Diler R, Birmaher B. A Longitudinal Study of Family Functioning in Offspring of Parents Diagnosed With Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2019; 58:961-970. [PMID: 30768400 PMCID: PMC6584080 DOI: 10.1016/j.jaac.2018.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/26/2018] [Accepted: 12/11/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the longitudinal course of family functioning in offspring of parents with bipolar disorder (BD), offspring of parents with non-BD psychopathology, and offspring of healthy control (HC) parents. METHOD Offspring of parents with BD (256 parents and 481 offspring), parents without BD (82 parents and 162 offspring), and HC parents (88 parents and 175 offspring) 7 to 18 years of age at intake, from the Bipolar Offspring Study (BIOS), were followed for an average of 4.3 years. Family functioning was evaluated using the child- and parent-reported Family Adaptability and Cohesion Scale-II and the Conflict Behavior Questionnaire. The data were analyzed using multivariate multilevel regression, generalized linear estimating equation models, and path analysis. RESULTS Families of parents with BD and parents with non-BD psychopathology showed lower cohesion and adaptability and higher conflict compared with HC families. There were no significant differences in cohesion and adaptability between families of parents with psychopathology. The effect of parental psychopathology on family functioning was mediated by parental psychosocial functioning and, to a lesser extent, offspring disorders. In all 3 groups, parent-reported family conflict was significantly higher than child-reported conflict. Across groups, family cohesion decreased over follow-up, whereas conflict increased. CONCLUSION Any parental psychopathology predicted family impairment. These results were influenced by the offspring's age and were mediated by parental psychosocial functioning and, to a lesser degree, by offspring psychopathology. These findings emphasize the need to routinely assess family functioning in addition to psychopathology and provide appropriate interventions to parents and offspring.
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Affiliation(s)
- Amit Shalev
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA; Herman Dana Division of Pediatric Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - John Merranko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
| | - Tina Goldstein
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
| | - David J. Miklowitz
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - David Axelson
- Children’s Hospital and The Ohio State University, Columbus
| | | | - David Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
| | - Kelly Monk
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
| | - Mary Beth Hickey
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
| | - Danella M. Hafeman
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
| | - Dara Sakolsky
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
| | - Rasim Diler
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA
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Estrada-Prat X, Van Meter AR, Camprodon-Rosanas E, Batlle-Vila S, Goldstein BI, Birmaher B. Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review. Bipolar Disord 2019; 21:483-502. [PMID: 31025494 PMCID: PMC6768757 DOI: 10.1111/bdi.12785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence. METHODOLOGY A systematic review of PubMed (1946-2017) and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria. RESULTS Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences. LIMITATIONS Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability. CONCLUSION Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved.
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Affiliation(s)
- Xavier Estrada-Prat
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
| | - Anna R. Van Meter
- The Feinstein Institute for Medical Research, The Zucker Hillside Hospital, Department of Psychiatry Research, Glen Oaks, NY
| | - Ester Camprodon-Rosanas
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
- Children and Adolescent Mental Health Research Group. Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Santiago Batlle-Vila
- Institut de Neuropsiquiatria i Addiccions, Centre de Salut Mental Infantil i Juvenil Sant Martí-La Mina i Ciutat Vella, Parc de Salut Mar, Barcelona, Spain
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Wang J, Hu S, Wang L. Multilevel analysis of personality, family, and classroom influences on emotional and behavioral problems among Chinese adolescent students. PLoS One 2018; 13:e0201442. [PMID: 30092068 PMCID: PMC6084894 DOI: 10.1371/journal.pone.0201442] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background The classroom environment plays a potentially important role in shaping the emotions and behavior of adolescents. However, few studies have focused on this factor. The aim of this study was to explore the association between the classroom environment and emotional and behavioral problems among Chinese adolescents while also considering personality-and family-related factors. Methods This cross-sectional study was conducted in November and December, 2009. A set of questionnaires, including the Strengths and Difficulties Questionnaire (SDQ), the Eysenck Personality Questionnaire (EPQ), the Family Environment Scale (FES), the Questionnaire on Teacher Interaction (QTI), and the Center for Epidemiological Studies- Depression Scale (CES-D), were distributed to participants. A total of 5,433 Chinese adolescent students (aged 9–18) and 244 classroom teachers in Liaoning Province were ultimately included in the study. Hierarchical linear modeling was used to explore the factors associated with emotional and behavioral problems. Results Multilevel analyses revealed that adolescent emotional and behavioral problems significantly varied among classrooms. Although personality and family characteristics exerted the greatest influence on adolescents’ emotions and behavior at the individual-level, interactions between classroom teachers and students increasingly affected adolescents with respect to age at the class-level. A mild positive association was found between adolescents’ mental health problems and the mental health of teachers. Conclusion This study focused on the classroom environment in order to understand Chinese adolescent mental health problems, the findings of which highlight important implications for policymakers and educators. The results underscore the importance of establishing a comfortable classroom climate by improving teacher-student interactions and meeting specific needs at different school stages, thus promoting a climate of positive mental health among Chinese adolescents.
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Affiliation(s)
- Jiana Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Shu Hu
- School of Humanities and Social Sciences, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
- * E-mail:
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MacPherson HA, Ruggieri AL, Christensen RE, Schettini E, Kim KL, Thomas SA, Dickstein DP. Developmental evaluation of family functioning deficits in youths and young adults with childhood-onset bipolar disorder. J Affect Disord 2018; 235:574-582. [PMID: 29702451 PMCID: PMC5976258 DOI: 10.1016/j.jad.2018.04.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/09/2018] [Accepted: 04/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood-onset bipolar disorder (BD) is a serious condition that affects the patient and family. While research has documented familial dysfunction in individuals with BD, no studies have compared developmental differences in family functioning in youths with BD vs. adults with prospectively verified childhood-onset BD. METHODS The Family Assessment Device (FAD) was used to examine family functioning in participants with childhood-onset BD (n = 116) vs. healthy controls (HCs) (n = 108), ages 7-30 years, using multivariate analysis of covariance and multiple linear regression. RESULTS Participants with BD had significantly worse family functioning in all domains (problem solving, communication, roles, affective responsiveness, affective involvement, behavior control, general functioning) compared to HCs, regardless of age, IQ, and socioeconomic status. Post-hoc analyses suggested no influence for mood state, global functioning, comorbidity, and most medications, despite youths with BD presenting with greater severity in these areas than adults. Post-hoc tests eliminating participants taking lithium (n = 17) showed a significant diagnosis-by-age interaction: youths with BD had worse family problem solving and communication relative to HCs. LIMITATIONS Limitations include the cross-sectional design, clinical differences in youths vs. adults with BD, ambiguity in FAD instructions, participant-only report of family functioning, and lack of data on psychosocial treatments. CONCLUSIONS Familial dysfunction is common in childhood-onset BD and endures into adulthood. Early identification and treatment of both individual and family impairments is crucial. Further investigation into multi-level, family-based mechanisms underlying childhood-onset BD may clarify the role family factors play in the disorder, and offer avenues for the development of novel, family-focused therapeutic strategies.
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Affiliation(s)
- Heather A. MacPherson
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA,Corresponding Author: Heather A. MacPherson, 1011 Veterans Memorial Parkway, East Providence, RI 02915, Phone: (401) 432-1162, Fax: (401) 432-1607,
| | - Amanda L. Ruggieri
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Rachel E. Christensen
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Elana Schettini
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Kerri L. Kim
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sarah A. Thomas
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel P. Dickstein
- Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA,Division of Child Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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21
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McAulay C, Mond J, Touyz S. Early intervention for bipolar disorder in adolescents: A psychosocial perspective. Early Interv Psychiatry 2018; 12:286-291. [PMID: 28836352 DOI: 10.1111/eip.12474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 01/28/2023]
Abstract
AIM Early intervention in bipolar disorder (BD) has received increasing attention in recent years. The identification of risk factors has improved, but researchers continue to struggle to find an effective treatment once the illness has become established. The aetiology of BD and feasibility of early intervention present a challenge, making it difficult to decide who to target, as well as how. METHODS This essay seeks to address the lack of guidance for managing patients with a possible emerging bipolar illness, by presenting a rough roadmap to psychological care. The psychological techniques currently showing the most potential for this challenging group are reviewed. Markers of risk and supplementary clinical targets, such as anxiety and sleep disruption, are also discussed. RESULTS While research in this group remains in its infancy, various avenues of enquiry show promise, such as family-based approaches, CBT that targets features beyond the core illness, psychoeducation, and interventions that consider physical health. However, clearer pathways for establishing the course and stage of the illness are required to inform the intensity and type of treatment. CONCLUSION It is argued that treating early, indistinct symptoms of psychological distress, that may or may not signify prodromal BD, is valuable beyond its utility as an early intervention tool, as it has the capacity to improve help-seeking behaviour, quality of life and the likelihood of functional recovery in those who go on to develop the illness as adults.
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Affiliation(s)
- Claire McAulay
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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Lee HJ, Lin ECL, Chen MB, Su TP, Chiang LC. Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers. Int J Ment Health Nurs 2018; 27:61-71. [PMID: 28000377 DOI: 10.1111/inm.12294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2016] [Indexed: 11/28/2022]
Abstract
Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem-solving (P = 0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.
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Affiliation(s)
- Hsiu-Ju Lee
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Esther Ching-Lan Lin
- Department of Nursing, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - Mei-Bih Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tung-Ping Su
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Chi Chiang
- School of Nursing, National Defense Medical Center and China Medical University, Taipei and Taichung, Taiwan
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Childhood maltreatment is associated with attachment insecurities, dissociation and alexithymia in bipolar disorder. Psychiatry Res 2018; 260:391-399. [PMID: 29253803 DOI: 10.1016/j.psychres.2017.12.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/10/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022]
Abstract
Child maltreatment is a public health issue that is a well-established risk factor for many psychological conditions, including bipolar disorder. The current study is one of the first to investigate associations among child maltreatment, dissociative symptomatology, alexithymia, anxiety, depression, and attachment insecurities. 40 patients with bipolar disorder-I and 40 healthy subjects matched for age, gender, and education participated in the study. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), Childhood Trauma Questionnaire (CTQ-28), Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scale (DASS-21), and Experiences in Close Relationships-Revised (ECR-R) were completed by participants. In comparison to control participants, patients with bipolar disorder-I reported significantly more frequent abusive experiences in childhood, higher levels of attachment insecurities, more severe pathological and somatoform dissociation, as well as higher scores on measures of alexithymia, anxiety, depression and psychological stress. Reports of psychopathology among first-degree relatives (OR = 102.169, 95%IC = 4.596-2271.255; P < 0.01) and childhood emotional trauma (OR = 1.032; 95%CI = 0.782-1.363, P = 0.05) significantly contributed to bipolar disorder-I diagnosis. In contrast, absorption was negatively associated with bipolar illness (OR = 0.852; 95% CI = 0.747-0.973, P < 0.05). Our results showed significant associations between childhood trauma exposure and risk of bipolar disorder. Moreover, the results demonstrate that emotional abuse exposure predicts bipolar illness.
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24
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Pan LA, Goldstein TR, Rooks BT, Hickey M, Fan JY, Merranko J, Monk K, Diler RS, Sakolsky DJ, Hafeman D, Iyengar S, Goldstein B, Kupfer DJ, Axelson D, Brent DA, Birmaher B. The Relationship Between Stressful Life Events and Axis I Diagnoses Among Adolescent Offspring of Probands With Bipolar and Non-Bipolar Psychiatric Disorders and Healthy Controls: The Pittsburgh Bipolar Offspring Study (BIOS). J Clin Psychiatry 2017; 78:e234-e243. [PMID: 28199068 PMCID: PMC5927547 DOI: 10.4088/jcp.15m09815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/18/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previous studies have explored the role of stressful life events in the development of mood disorders. We examined the frequency and nature of stressful life events as measured by the Stressful Life Events Schedule (SLES) among 3 groups of adolescent offspring of probands with bipolar (BD), with non-BD psychiatric disorders, and healthy controls. Furthermore, we examined the relationship between stressful life events and the presence of DSM-IV Axis I disorders in these offspring. Stressful life events were characterized as dependent, independent, or uncertain (neither dependent nor independent) and positive, negative, or neutral (neither positive nor negative). METHODS Offspring of probands with BD aged 13-18 years (n = 269), demographically matched offspring of probands with non-BD Axis I disorders (n = 88), and offspring of healthy controls (n = 81) from the Pittsburgh Bipolar Offspring Study were assessed from 2002 to 2007 with standardized instruments at intake. Probands completed the SLES for their offspring for life events within the prior year. Life events were evaluated with regard to current Axis I diagnoses in offspring after adjusting for confounds. RESULTS After adjusting for demographic and clinical between-group differences (in probands and offspring), offspring of probands with BD had greater independent (χ² = 11.96, P < .04) and neutral (χ² = 17.99, P < .003) life events compared with offspring of healthy controls and greater number of more severe stressful life events than offspring of healthy controls, but not offspring of probands with non-BD. Offspring of BD probands with comorbid substance use disorder reported more independent stressful life events compared to those without comorbid substance use disorder (P = .024). Greater frequency and severity of stressful life events were associated with current Axis I disorder in offspring of both probands with BD and probands with other Axis I disorders regardless of dependency or valence. Greater frequency and severity of stressful life events were associated with greater current Axis I disorder in all offspring. CONCLUSIONS Offspring of probands with BD have greater exposure to independent and neutral life events than offspring of healthy controls. Greater frequency and severity of stressful life events were associated with Axis I disorder in offspring of both BD and non-BD affected probands.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Benjamin Goldstein
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | | | - David Axelson
- Nationwide Children’s Hospital / The Ohio State University College of Medicine
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25
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Perez Algorta G, MacPherson HA, Youngstrom EA, Belt CC, Arnold LE, Frazier TW, Taylor HG, Birmaher B, Horwitz SM, Findling RL, Fristad MA. Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:S306-S320. [PMID: 28278600 DOI: 10.1080/15374416.2017.1280805] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Caregivers of psychiatrically impaired children experience considerable parenting stress. However, no research has evaluated parenting stress within the context of pediatric bipolar spectrum disorders (BPSD). Thus, the aim of this investigation was to identify predictors and moderators of stress among caregivers in the Longitudinal Assessment of Manic Symptoms study. Participants included 640 children and their caregivers in the Longitudinal Assessment of Manic Symptoms cohort. Children had a mean age of 9.4 ± 1.9 years (68% male, 23% BPSD); parents had a mean age of 36.5 ± 8.3 years (84% mothers). Children with BPSD had more service utilization, psychiatric diagnoses, mood and anxiety symptoms, and functional impairment but fewer disruptive behavior disorders. Caregivers of children with BPSD were more likely than caregivers of children without BPSD to have a partner, elevated depressive symptoms, antisocial tendencies, and parenting stress (Cohen's d = .49). For the whole sample, higher child IQ, mania, anxiety, disruptive behavior, and caregiver depression predicted increased parenting stress; maternal conduct disorder predicted lower stress. Child anxiety and disruptive behavior were associated with elevated caregiver stress only for non-BPSD children. Caregivers of children with BPSD experience significant burden and thus require specialized, family-focused interventions. As stress was also elevated, to a lesser degree, among depressed caregivers of children with higher IQ, mania, anxiety, and disruptive behavior, these families may need additional supports as well. Although parents with conduct/antisocial problems evidenced lower stress, these difficulties should be monitored. Thus, parenting stress should be evaluated and addressed in the treatment of childhood mental health problems, especially BPSD.
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Affiliation(s)
- Guillermo Perez Algorta
- a Spectrum Centre for Mental Health Research/Division of Health Research , Lancaster University
| | | | - Eric A Youngstrom
- c Department of Psychology , University of North Carolina at Chapel Hill
| | | | - L Eugene Arnold
- e Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | | | - H Gerry Taylor
- g Department of Pediatrics , Case Western Reserve University and Rainbow Babies & Children's Hospital
| | - Boris Birmaher
- h Department of Psychiatry , University of Pittsburgh Medical Center
| | - Sarah McCue Horwitz
- i Department of Child and Adolescent Psychiatry , New York University School of Medicine
| | - Robert L Findling
- j Department of Psychiatry , Johns Hopkins University/Kennedy Krieger Institute
| | - Mary A Fristad
- e Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center.,k The LAMS Team
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26
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Reinares M, Bonnín CM, Hidalgo-Mazzei D, Colom F, Solé B, Jiménez E, Torrent C, Comes M, Martínez-Arán A, Sánchez-Moreno J, Vieta E. Family functioning in bipolar disorder: Characteristics, congruity between patients and relatives, and clinical correlates. Psychiatry Res 2016; 245:66-73. [PMID: 27526319 DOI: 10.1016/j.psychres.2016.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 01/17/2023]
Abstract
Functional improvement has become one of the aims of the treatment of bipolar disorder. However, scant attention has been given to family functioning, even though it has a role in the illness outcome and is affected by the disorder. The aims of this study were to compare family functioning reported by euthymic patients with bipolar disorder and healthy controls; explore the level of congruence in the perception of family environment between patients with bipolar disorder and their relatives; and analyse the relationship between clinical variables and family functioning. The sample comprised 82 adult euthymic subjects with bipolar disorder, 82 family caregivers of these patients and 47 healthy controls. Participants completed the Family Environment Scale. Results showed moderate correlations and a mean pattern almost identical between relatives' and patients' reported scores in family functioning subscales. There were significant differences between patients and controls, favourable for the latter, in the subscales cohesion (p<0.005), expressiveness (p=0.002), conflict (p=0.038), intellectual-cultural orientation (p=0.001), active-recreational orientation (p<0.005), and a non-significant trend in organization (p=0.064). Significant associations were found between family environment and clinical variables of severity. These findings contribute to increasing the understanding of family functioning in bipolar disorder and highlight the importance of family work.
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Affiliation(s)
- María Reinares
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
| | - C Mar Bonnín
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Francesc Colom
- Mental Health Group, IMIM-Hospital del Mar-CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Solé
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Esther Jiménez
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Carla Torrent
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Mercè Comes
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Anabel Martínez-Arán
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - José Sánchez-Moreno
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Eduard Vieta
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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27
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Salcedo S, Gold AK, Sheikh S, Marcus PH, Nierenberg AA, Deckersbach T, Sylvia LG. Empirically supported psychosocial interventions for bipolar disorder: Current state of the research. J Affect Disord 2016; 201:203-14. [PMID: 27243619 DOI: 10.1016/j.jad.2016.05.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/29/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Bipolar disorder requires psychiatric medications, but even guideline-concordant treatment fails to bring many patients to remission or keep them euthymic. To address this gap, researchers have developed adjunctive psychotherapies. The purpose of this paper is to critically review the evidence for the efficacy of manualized psychosocial interventions for bipolar disorder. METHODS We conducted a search of the literature to examine recent (2007-present), randomized controlled studies of the following psychotherapy interventions for bipolar disorder: psychoeducation (PE), cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), and family therapies such as family focused therapy (FFT). RESULTS All of the psychotherapy interventions appear to be effective in reducing depressive symptoms. Psychoeducation and CBT are associated with increased time to mood episode relapse or recurrence. MBCT has demonstrated a particular effectiveness in improving depressive and anxiety symptoms. Online psychotherapy interventions, programs combining one or more psychotherapy interventions, and targeted interventions centering on particular symptoms have been the focus of recent, randomized controlled studies in bipolar disorder. CONCLUSIONS Psychotherapy interventions for the treatment of bipolar disorder have substantial evidence for efficacy. The next challenge will to disseminate these psychotherapies into the community.
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Affiliation(s)
- Stephanie Salcedo
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
| | - Alexandra K Gold
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sana Sheikh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychology, Suffolk University, Boston, MA, USA
| | - Peter H Marcus
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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28
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Miklowitz DJ, Chung B. Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. FAMILY PROCESS 2016; 55:483-99. [PMID: 27471058 PMCID: PMC5922774 DOI: 10.1111/famp.12237] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Family-focused therapy (FFT) is an evidence-based intervention for adults and children with bipolar disorder (BD) and their caregivers, usually given in conjunction with pharmacotherapy after an illness episode. The treatment consists of conjoint sessions of psychoeducation regarding bipolar illness, communication enhancement training, and problem-solving skills training. This paper summarizes over 30 years of research on FFT and family processes in BD. Across eight randomized controlled trials with adults and adolescents with BD, FFT and mood-stabilizing medications have been found to hasten recovery from mood episodes, reduce recurrences, and reduce levels of symptom severity compared to briefer forms of psychoeducation and medications over 1-2 years. Several studies indicate that the effects of FFT on symptom improvement are greater among patients with high-expressed emotion relatives. New research focuses on FFT as an early intervention for youth at risk for BD, neuroimaging as a means of evaluating treatment mechanisms, and progress in implementing FFT in community mental health settings.
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Affiliation(s)
- David J Miklowitz
- Department of Psychiatry and Behavioral Sciences, UCLA School of Medicine, Los Angeles, CA.
| | - Bowen Chung
- Department of Psychiatry and Behavioral Sciences, UCLA School of Medicine, Los Angeles, CA
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29
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MacPherson HA, Weinstein SM, Henry DB, West AE. Mediators in the randomized trial of Child- and Family-Focused Cognitive-Behavioral Therapy for pediatric bipolar disorder. Behav Res Ther 2016; 85:60-71. [PMID: 27567973 DOI: 10.1016/j.brat.2016.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/20/2016] [Accepted: 08/17/2016] [Indexed: 12/24/2022]
Abstract
Mediation analyses can identify mechanisms of change in Cognitive-Behavioral Therapy (CBT). However, few studies have analyzed mediators of CBT for youth internalizing disorders; only one trial evaluated treatment mechanisms for youth with mixed mood diagnoses. This study evaluated mediators in the randomized trial of Child- and Family-Focused CBT (CFF-CBT) versus Treatment As Usual (TAU) for pediatric bipolar disorder (PBD), adjunctive to pharmacotherapy. Sixty-nine children ages 7-13 with PBD were randomly assigned to CFF-CBT or TAU. Primary outcomes (child mood, functioning) and candidate mediators (family functioning, parent/child coping) were assessed at baseline and 4-, 8-, 12- (post-treatment), and 39-weeks (follow-up). Compared with TAU, children receiving CFF-CBT exhibited greater improvement in mania, depression, and global functioning. Several parent and family factors significantly improved in response to CFF-CBT versus TAU, and were associated with the CFF-CBT treatment effect. Specifically, parenting skills and coping, family flexibility, and family positive reframing showed promise as mediators of child mood symptoms and global functioning. Main or mediating effects for youth coping were not significant. CFF-CBT may impact children's mood and functioning by improving parenting skills and coping, family flexibility, and family positive reframing. Findings highlight the importance of parent coping and family functioning in the treatment of PBD.
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Affiliation(s)
- Heather A MacPherson
- University of Illinois at Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, USA.
| | - Sally M Weinstein
- University of Illinois at Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, USA
| | - David B Henry
- University of Illinois at Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, USA
| | - Amy E West
- University of Illinois at Chicago, Department of Psychiatry, 1747 West Roosevelt Road, Chicago, IL 60608, USA
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Johnson SL, Cuellar A, Gershon A. The Influence of Trauma, Life Events, and Social Relationships on Bipolar Depression. Psychiatr Clin North Am 2016; 39:87-94. [PMID: 26876320 PMCID: PMC4756278 DOI: 10.1016/j.psc.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A growing body of research suggests that the social environment exerts a powerful influence on the course of bipolar depression. This article reviews longitudinal research to suggest that trauma, negative life events, social support deficits, and family difficulties are common and predict a more severe course of depression when present among those diagnosed with bipolar disorder. The triggers of bipolar depression overlap with those documented for unipolar depression, suggesting that many of the treatment targets for unipolar depression may be applicable for bipolar depression.
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Affiliation(s)
- Sheri L. Johnson
- Department of Psychology, University of California Berkeley, 3210 Tolman Hall, MC 1650, Psychology, University of California, Berkeley, CA 94720-1659,
| | | | - Anda Gershon
- Department of Psychiatry, Stanford University, 401 Quarry Road, Stanford, CA 94305-5719,
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31
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Van Meter A, Youngstrom E, Freeman A, Feeny N, Youngstrom JK, Findling RL. Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder. J Child Adolesc Psychopharmacol 2016; 26:26-37. [PMID: 26835744 PMCID: PMC4779275 DOI: 10.1089/cap.2015.0111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Research on adults with cyclothymic disorder (CycD) suggests that irritability and impulsive aggression (IA) are highly prevalent among this population. Less is known about whether these behaviors might also distinguish youth with CycD from youth without CycD. Additionally, little is known about how irritability and IA relate to one another, and whether they are associated with different outcomes. This study aimed to compare irritability and IA across diagnostic subtypes to determine whether CycD is uniquely associated with these behaviors, and to assess how irritability and IA relate to youth social and general functioning. METHODS Participants (n = 459), 11-18 years of age, were recruited from an urban community mental health center and an academic outpatient clinic; 25 had a diagnosis of CycD. Youth and caregivers completed measures of IA and irritability. Youth and caregivers also completed an assessment of youth friendship quality. Clinical interviewers assessed youth social, family, and school functioning. RESULTS Youth with CycD had higher scores on measures of irritability and IA than youth with nonbipolar disorders, but scores were not different from other youth with bipolar spectrum disorders. Measures of irritability and IA were correlated, but represented distinct constructs. Regression analyses indicated that irritability was related to friendship quality (p < 0.005). Both IA and irritability were related to social impairment (ps < 0.05-0.0005) and Child Global Assessment Scale (C-GAS) scores (ps = 0.05-0.005). CycD diagnosis was associated with poorer caregiver-rated friendship quality and social functioning (ps < 0.05). CONCLUSIONS We found that irritability and aggression were more severe among youth with CycD than among youth with nonbipolar diagnoses, but did not differ across bipolar disorder subtypes. Among youth seeking treatment for mental illness, irritability and IA are prevalent and nonspecific. Irritability and IA were uniquely related to our outcomes of social and general functioning, suggesting that it is worthwhile to assess each separately, in order to broaden our understanding of the characteristics and correlates of each.
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Affiliation(s)
- Anna Van Meter
- Ferkauf Graduate School, Yeshiva University, Bronx, New York
| | - Eric Youngstrom
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew Freeman
- Department of Psychology,The University of Nevada at Las Vegas, Las Vegas, Nevada
| | - Norah Feeny
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio
| | - Jennifer Kogos Youngstrom
- Department of Psychology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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32
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Reinares M, Bonnín C, Hidalgo-Mazzei D, Sánchez-Moreno J, Colom F, Vieta E. The role of family interventions in bipolar disorder: A systematic review. Clin Psychol Rev 2016; 43:47-57. [DOI: 10.1016/j.cpr.2015.11.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/01/2015] [Accepted: 11/09/2015] [Indexed: 12/19/2022]
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33
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Balsan G, Corcos M. [Adolescent manic-depressive disorders: Clinical aspects]. Arch Pediatr 2016; 23:417-23. [PMID: 26790339 DOI: 10.1016/j.arcped.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/17/2022]
Abstract
More than 50% of bipolar disorders diagnosed among adults first appeared before the age of 18. It is well established that adolescence is the high-risk period for the onset of major mood episodes associated with bipolar disorders. Even though there are few early-onset bipolar disorders, they are very severe. The most robust risk factor predicting bipolar disorder is a positive family history. Morbidity, mortality, and suicidality are high and have a severe impact on overall functioning, professional integration, family life, and affective relationships. Improving diagnosis of early symptoms should ameliorate these patients' prognosis.
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Affiliation(s)
- G Balsan
- Département de psychiatrie de l'adolescent et du jeune adulte, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
| | - M Corcos
- Département de psychiatrie de l'adolescent et du jeune adulte, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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Correlates of Adolescent-reported and Parent-reported Family Conflict Among Canadian Adolescents With Bipolar Disorder. J Psychiatr Pract 2016; 22:31-41. [PMID: 26813486 DOI: 10.1097/pra.0000000000000118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Family conflict exacerbates the course of bipolar disorder (BP) among adults. However, few studies have examined family conflict among adolescents with BP, and fewer have looked at adolescent-reported and parent-reported family conflict separately. METHODS Subjects were 89 adolescents, aged 13 to 19 years, with a diagnosis of BP on the basis of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL). Subjects were divided into high-conflict and low-conflict groups using a median split on the Conflict Behavior Questionnaire (child report and parent report). The χ(2) analyses and independent samples t tests were performed for univariate analyses. Multivariable logistic regression analyses were performed on variables with P<0.2. RESULTS Parent-reported and adolescent-reported Conflict Behavior Questionnaire scores were significantly correlated (r=0.50, P<0.001). High parent-reported family conflict was positively associated with recent manic symptoms, externalizing comorbidities, and dimensional scores reflecting emotional dysregulation. High adolescent-reported family conflict was positively associated with recent manic symptoms and emotional dysregulation, and negatively associated with socioeconomic status and lifetime psychiatric hospitalization. Bipolar subtype was significantly associated with high versus low family conflict. LIMITATIONS The limitations of this study included being a cross-sectional study, use of a medium-sized sample, and lack of a control group. CONCLUSIONS Despite substantial agreement between adolescents and parents regarding the amount of family conflict, there were meaningful differences in the factors associated with adolescent-reported and parent-reported conflict. These findings demonstrate the importance of ascertaining family conflict from adolescents as well as from parents. Moreover, these findings can potentially inform family therapy, which is known to be effective for adolescents with BP.
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35
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Çuhadar D, Savaş HA, Ünal A, Gökpınar F. Family Functionality and Coping Attitudes of Patients with Bipolar Disorder. JOURNAL OF RELIGION AND HEALTH 2015; 54:1731-1746. [PMID: 25086849 DOI: 10.1007/s10943-014-9919-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The coping of patients with prodromal syndromes prevents relapses, and the differences in coping strategies affect the results of bipolar disorder. The various functionality levels of bipolar disorder patients such as work, marital relations, parental abilities and social presentation are significantly related with how well they cope. The objective of this study was to determine the family functionality and coping attitudes of bipolar disorder patients. The study planned as a descriptive one was carried with 81 bipolar disorder patients. Personal description form, family assessment device and Coping Attitudes Scale were used as data acquisition tools. It was determined that the adaptive coping attitudes used most frequently by the patients were religious coping, positive reinterpretation, active coping, problem-focused coping and emotional focused coping, beneficial social support use, emotional social support use, planning, suppression of competing activities and restraint coping; maladaptive coping attitudes used most frequently by the patients were "focusing on the problem and venting of emotions and mental disengagement." It was determined that family functions affected the coping attitudes of patients and that the patients who evaluated family functions in a healthy manner made use of adaptive coping strategies more at a statistically significant level.
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Affiliation(s)
- Döndü Çuhadar
- Psychiatric Nursing Department, Health Science Faculty, Gaziantep University, 27100, Şahinbey, Gaziantep, Turkey,
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Klaus NM, Algorta GP, Young AS, Fristad MA. Validity of the Expressed Emotion Adjective Checklist (EEAC) in Caregivers of Children with Mood Disorders. COUPLE & FAMILY PSYCHOLOGY 2015; 4:27-38. [PMID: 25729632 PMCID: PMC4339054 DOI: 10.1037/cfp0000036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Expressed Emotion (EE; criticism/hostility and emotional overinvolvement) displayed in family interactions has been associated with the presence and poorer course of multiple disorders in adults and children. As such, validating appropriate tools for measuring EE could have important implications for research and clinical practice. Child EE measures are limited though there are some established methods of assessing EE in adults. The Expressed Emotion Adjective Checklist (EEAC), a self-report measure of EE, has demonstrated validity with adults but has not been evaluated in child samples. The present study examined reliability, stability, and validity of the EEAC in measuring EE in caregivers of children with mood disorders. EEAC scores were associated with the criticism component of the Five Minute Speech Sample (FMSS), a commonly used EE measure in children. EEAC scores were also stable and predicted manic symptom severity and global impairment one year later. These data suggest the EEAC may be a useful self-report measure of EE in children.
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Longitudinal associations between interpersonal relationship functioning and mood episode severity in youth with bipolar disorder. J Nerv Ment Dis 2015; 203:194-204. [PMID: 25668652 PMCID: PMC4342291 DOI: 10.1097/nmd.0000000000000261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the longitudinal association between mood episode severity and relationships in youth with bipolar (BP) disorder. Participants were 413 Course and Outcome of Bipolar Youth study youth, aged 12.6 ± 3.3 years. Monthly ratings of relationships (parents, siblings, and friends) and mood episode severity were assessed by the Adolescent Longitudinal Interval Follow-up Evaluation Psychosocial Functioning Schedule and Psychiatric Rating Scales, on average, every 8.2 months over 5.1 years. Correlations examined whether participants with increased episode severity also reported poorer relationships and whether fluctuations in episode severity predicted fluctuations in relationships, and vice versa. Results indicated that participants with greater mood episode severity also had worse relationships. Longitudinally, participants had largely stable relationships. To the extent that there were associations, changes in parental relationships may precede changes in episode severity, although the magnitude of this finding was small. Findings have implications for relationship interventions in BP youth.
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Frías Á, Palma C, Farriols N. Psychosocial interventions in the treatment of youth diagnosed or at high-risk for pediatric bipolar disorder: A review of the literature. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2015; 8:146-56. [PMID: 25620426 DOI: 10.1016/j.rpsm.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/17/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
Pediatric bipolar disorder (PBD) has emerged as a research field in which psychosocial treatments have provided a plethora of empirical findings over the last decade. We addressed this issue through a systematic review aimed of establishing their effectiveness and feasibility as adjunctive therapies for youth with PBD or at high-risk for PBD. A comprehensive search of databases was performed between 1990 and September 2014. Overall, 33 studies were specifically related to the issue and 20 of them were original articles. Evidence suggests that both "multi-family psychoeducational psychotherapy' and "family-focused therapy" are possible effective treatments for PBD. Likewise, "child and family-focused cognitive-behavioral therapy" may be characterized as a treatment in its experimental phase. The remaining therapies fail to obtain enough empirical support due to inconsistent findings among clinical trials or data solely based on case reports. Studies of psychosocial treatments provide concluding results concerning their feasibility and acceptability. Larger sample sizes and more randomized controlled trials are mandatory for diminishing methodological shortcomings encountered in the treatments displayed.
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Affiliation(s)
- Álvaro Frías
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España.
| | - Cárol Palma
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España
| | - Núria Farriols
- Facultat de Psicologia, Ciències de l'Educació i l'Esport (FPCEE) Blanquerna, Universidad de Ramon-Llull, Barcelona, España
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Fonseka TM, Swampillai B, Timmins V, Scavone A, Mitchell R, Collinger KA, Goldstein BI. Significance of borderline personality-spectrum symptoms among adolescents with bipolar disorder. J Affect Disord 2015; 170:39-45. [PMID: 25233237 DOI: 10.1016/j.jad.2014.08.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 07/27/2014] [Accepted: 08/12/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known regarding correlates of borderline personality-spectrum symptoms (BPSS) among adolescents with bipolar disorder (BP). METHODS Participants were 90 adolescents, 13-19 years of age, who fulfilled DSM-IV-TR criteria for BP using semi-structured diagnostic interviews. BPSS status was ascertained using the Life Problems Inventory which assessed identity confusion, interpersonal problems, impulsivity, and emotional lability. Analyses compared adolescents with "high" versus "low" BPSS based on a median split. RESULTS Participants with high, relative to low, BPSS were younger, and had greater current and past depressive episode severity, greater current hypo/manic episode severity, younger age of depression onset, and reduced global functioning. High BPSS participants were more likely to have BP-II, and had higher rates of social phobia, generalized anxiety disorder, conduct disorder, oppositional defiant disorder, homicidal ideation, assault of others, non-suicidal self-injury, suicidal ideation, and physical abuse. Despite greater illness burden, high BPSS participants reported lower rates of lithium use. The most robust independent predictors of high BPSS, identified in multivariate analyses, included lifetime social phobia, non-suicidal self-injury, reduced global functioning, and conduct and/or oppositional defiant disorder. LIMITATIONS The study design is cross-sectional and cannot determine causality. CONCLUSIONS High BPSS were associated with greater mood symptom burden and functional impairment. Presence of high BPSS among BP adolescents may suggest the need to modify clinical monitoring and treatment practices. Future prospective studies are needed to examine the direction of observed associations, the effect of treatment on BPSS, and the effect of BPSS as a moderator or predictor of treatment response.
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Affiliation(s)
- Trehani M Fonseka
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brenda Swampillai
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Vanessa Timmins
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Antonette Scavone
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Rachel Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Katelyn A Collinger
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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Ellis AJ, Portnoff LC, Axelson DA, Kowatch RA, Walshaw P, Miklowitz DJ. Parental expressed emotion and suicidal ideation in adolescents with bipolar disorder. Psychiatry Res 2014; 216:213-6. [PMID: 24589450 PMCID: PMC4026267 DOI: 10.1016/j.psychres.2014.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 02/05/2014] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
Abstract
Family environmental variables are risk factors for recurrent courses of mood disorder in adolescents. The present study examined the association between parental expressed emotion (EE)-critical, hostile and/or emotionally overinvolved attitudes toward a concurrently ill offspring-and suicidal ideation in adolescents with bipolar disorder. The sample consisted of 95 adolescents with a bipolar I or II diagnosis who had experienced a mood episode in the prior 3 months. Participants (mean age=15.54 years, S.D.=1.4) were interviewed and completed questionnaires regarding current and past suicidal ideation prior to their participation in a treatment trial. Parents completed five-minute speech samples from which levels of EE were assessed. High EE attitudes in parents were associated with current suicidal ideation in adolescents. This relationship was independent of the effects of age, gender, current depressive or manic symptoms, comorbid diagnoses, bipolar I/II subtypes, family adaptability, and family cohesion. These results underscore the importance of addressing the emotional reactivity of caregivers in treating adolescents with bipolar disorder who have suicidal ideation.
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Affiliation(s)
- Alissa J Ellis
- University of California-Los Angeles, Semel Institute of Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, 760 Westwood Plaza, Los Angeles, CA 90025, USA.
| | - Larissa C Portnoff
- University of California-Los Angeles, Semel Institute of Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, 760 Westwood Plaza, Los Angeles, CA 90025, USA
| | - David A Axelson
- University of Pittsburgh Medical Center, Western Psychiatric Institute, Pittsburgh, PA, USA
| | - Robert A Kowatch
- Ohio State Wexner Medical Center, Columbus, OH, USA; Nationwide Children׳s Hospital, Columbus, OH, USA
| | - Patricia Walshaw
- University of California-Los Angeles, Semel Institute of Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, 760 Westwood Plaza, Los Angeles, CA 90025, USA
| | - David J Miklowitz
- University of California-Los Angeles, Semel Institute of Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, 760 Westwood Plaza, Los Angeles, CA 90025, USA
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Sheftall AH, Mathias CW, Furr RM, Dougherty DM. Adolescent attachment security, family functioning, and suicide attempts. Attach Hum Dev 2013; 15:368-83. [PMID: 23560608 DOI: 10.1080/14616734.2013.782649] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Theories of suicidal behavior suggest that the desire to die can arise from disruption of interpersonal relationships. Suicide research has typically studied this from the individual's perspective of the quality/frequency of their social interactions; however, the field of attachment may offer another perspective on understanding an individual's social patterns and suicide risk. This study examined attachment along with broader family functioning (family adaptability and cohesion) among 236 adolescent psychiatric inpatients with (n = 111) and without (n = 125) histories of suicide attempts. On average, adolescents were 14 years of age and Hispanic (69%). Compared to those without suicide attempts, adolescent attempters had lower self-reported maternal and paternal attachment and lower familial adaptability and cohesion. When comparing all three types of attachment simultaneously in the logistic regression model predicting suicide attempt status, paternal attachment was the only significant predictor. Suicide attempt group was also significantly predicted by self-rated Cohesion and Adaptability; neither of the parent ratings of family functioning were significant predictors. These findings are consistent with the predictions of the Interpersonal Theory of Suicide about social functioning and support the efforts to develop attachment-based interventions as a novel route towards suicide prevention.
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Affiliation(s)
- Arielle H Sheftall
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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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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