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Klein CC, Bruns KM, McLaughlin LE, Blom TJ, Patino Duran LR, DelBello MP. Family environment of youth with first episode Mania. Clin Child Psychol Psychiatry 2023; 28:1279-1290. [PMID: 36475895 DOI: 10.1177/13591045221141773] [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: 12/12/2022]
Abstract
BACKGROUND The purpose is to compare youth- and caregiver-reported characteristics of family environment, within and between families with a child experiencing a first manic episode of bipolar disorder (BPD), and families without a child with BPD or familial history of psychiatric disorders (HF). METHODS Family environment of 61 families with a child with BPD and 44 HF were assessed with Family Environment Scale (FES). We compared FES subscale scores between families with BPD and HF, and caregiver- and youth-rated scores. RESULTS Families with BPD differed significantly from HF on 8/10 FES subscales scores. Youth differed significantly from their caregivers on 7/10 subscales. An interaction effect was observed such that youth with BPD reported lower cohesion and organization, and higher conflict than their caregivers; however, HF did not differ significantly on these domains. CONCLUSIONS Our results suggest that families with BPD have higher conflict and lower cohesion and organization compared to HF. Results also indicate differences between youth and caregiver perspectives in both groups, which may contribute to family discord. Interventions targeting areas of cohesion, organization, and conflict may be beneficial for youth with BPD and their families, specifically those that identify and bridge perceptual divides.
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Affiliation(s)
- Christina C Klein
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, USA
| | - Kaitlyn M Bruns
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, USA
| | | | - Thomas J Blom
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, USA
| | | | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, USA
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2
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Ghitoli N, Rezaie L, Elahi A. Efficacy and Side Effects of Aripiprazole and Olanzapine in Patients with Psychotic Disorders: A Randomized Controlled Trial. Oman Med J 2023; 38:e553. [PMID: 38249132 PMCID: PMC10800020 DOI: 10.5001/omj.2023.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/14/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives In clinical experience, selecting atypical antipsychotics optimally balancing their benefits and potential side effects is seen to improve treatment adherence in patients. This study aimed to compare the effectiveness and side effect profiles of aripiprazole and olanzapine in patients with psychotic disorders. Methods In this double-blind clinical trial, the subjects were patients with psychotic disorders treated with aripiprazole and olanzapine. The subjects were randomly divided into two equally sized groups. One group was treated with olanzapine and the other group with aripiprazole. All participants were assessed using the positive and negative syndrome scale and side effects were monitored over a two-month follow-up period. Results The participants comprised N = 76 patients (65 male; 11 female). Treatments with both aripiprazole (n = 38) and olanzapine (n = 38) were associated with a significant decrease in the severity of psychotic symptoms over the two-month treatment period. This decrease was achieved faster in the olanzapine group. There were no significant differences in the changes in body mass index, waist circumference, blood sugar, triglyceride, or cholesterol between the two groups. A qualitative difference between the groups was found in their total sleep duration. Conclusions Olanzapine was more effective than aripiprazole in reducing psychotic symptoms. There were no significant differences between the overall side effect profiles of the two drugs.
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Affiliation(s)
- Nima Ghitoli
- Department of Psychiatry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leeba Rezaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Adele Elahi
- Department of Psychiatry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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3
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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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4
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Wong NR, Carta KE, Weintraub MJ, Miklowitz DJ. Therapeutic alliance in family therapy and clinical outcomes among adolescents at risk for mood disorders. J Affect Disord 2022; 300:66-70. [PMID: 34952128 PMCID: PMC8971051 DOI: 10.1016/j.jad.2021.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/27/2021] [Accepted: 12/19/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Family-focused therapy (FFT) is associated with longer intervals between mood episodes and reductions in suicidal ideation among adolescents at risk for bipolar disorders. However, the mediating processes underlying the efficacy of FFT are not well understood. In an open trial of an 18-week FFT program, we explored the association between the therapeutic alliance of adolescents/parents with their therapists and the symptomatic outcomes of adolescents over 18 weeks. METHOD Participants were enrolled in a treatment development trial of FFT supplemented with a mobile app. We used the System for Observing Family Therapeutic Alliances (SOFTA) to rate alliance between adolescents, parents, and therapists using videotaped FFT sessions from the beginning and end of treatment. Pearson correlations were computed between SOFTA alliance ratings and changes in Children's Depression Rating Scale, Revised (CDRS-R) scores over 18 weeks of treatment. RESULTS SOFTA ratings were obtained from sessions conducted with 17 adolescents (mean age 14.9+/-2.0 years; 41.2% female) and 22 parents. CDRS-R ratings were obtained from 16 adolescents at baseline and 18 weeks. Parents had significantly higher levels of engagement and emotional connection with therapists than their offspring. Adolescents' therapeutic engagement scores were significantly correlated with reductions in CDRS scores over 18 weeks (r(14) = -0.58, p = 0.018; N = 16). LIMITATIONS We could not draw conclusions about the causal relationship between therapeutic alliance and improvement in depression. CONCLUSIONS Among high-risk adolescents undergoing FFT, therapeutic alliance is associated with clinical improvement over 4 months. Strategies to enhance adolescent engagement may strengthen the long-term effects of family interventions.
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5
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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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6
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Liu L, Meng M, Zhu X, Zhu G. Research Status in Clinical Practice Regarding Pediatric and Adolescent Bipolar Disorders. Front Psychiatry 2022; 13:882616. [PMID: 35711585 PMCID: PMC9197260 DOI: 10.3389/fpsyt.2022.882616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022] Open
Abstract
Bipolar disorders (BDs) have high morbidity. The first onset of 27.7% of BDs occurs in children under 13 years and of 37.6% occurs in adolescents between 13 and 18 years. However, not all of the pediatric and adolescent patients with BD receive therapy in time. Therefore, studies about pediatric and adolescent patients with disorders have aroused increased attention in the scientific community. Pediatric and adolescent patients with BD present with a high prevalence rate (0.9-3.9%), and the pathogenic factors are mostly due to genetics and the environment; however, the pathological mechanisms remain unclear. Pediatric and adolescent patients with BD manifest differently from adults with BDs and the use of scales can be helpful for diagnosis and treatment evaluation. Pediatric and adolescent patients with BDs have been confirmed to have a high comorbidity rate with many other kinds of disorders. Both medication and psychological therapies have been shown to be safe and efficient methods for the treatment of BD. This review summarizes the research status related to the epidemiology, pathogenic factors, clinical manifestations, comorbidities, diagnostic and treatment scales, medications, and psychological therapies associated with BDs.
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Affiliation(s)
- Lu Liu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Ming Meng
- Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Shenyang Mental Health Center, Shenyang, China
| | - Xiaotong Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Psychiatry, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Gang Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
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Sharma A, Nehra R, Grover S. Correlates of expressed emotions as perceived by patients with bipolar disorder. Int J Soc Psychiatry 2021; 67:632-642. [PMID: 33092445 DOI: 10.1177/0020764020966633] [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] [Indexed: 11/15/2022]
Abstract
AIM To evaluate expressed emotions (EEs) as perceived by the patients and its correlates among patients with bipolar disorder (BD). METHODOLOGY One hundred patients diagnosed with BD were assessed on the Perceived Criticism Measure (PCM), Family emotional involvement and criticism scale (FEICS), Brief dyadic scale for expressed emotions (BDSEE) and Vulnerability for abuse screening scale (VASS) to assess EE and possible abuse by the caregivers. Caregivers were evaluated on family burden interview schedule and family coping questionnaire. RESULTS Longer duration of illness (Pearson's correlation coefficient: -0.335; p = .001***) and longer duration of treatment (Pearson's correlation coefficient: -0.317; p = .001***) were associated with significantly lower perceived criticism as assessed by FEICS. Higher use of coping mechanisms such as coercion, avoidance and resignation by caregivers were associated with the higher perception of EE, whereas the use of coping mechanisms such as information seeking, communication, and social involvement by the caregivers was associated with the perception of lower EE among the patients. Higher caregiver burden was associated with a higher perception of the EE by the patients. Higher perception of abuse by the patients was associated with higher EE. CONCLUSIONS Present study suggests that higher use of maladaptive coping, caregiver burden, and abuse has a significant impact on the EE. Accordingly, psychosocial interventions need to focus on caregivers to reduce EE.
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Affiliation(s)
- Ayush Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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8
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Abstract
Irritability, anger, and aggression, although not specific for pediatric bipolar disorder (BD), can be a common finding and an important source of distress and impairment in these patients. Over the past 2 decades the diagnostic significance of irritability in pediatric BD has been highly debated. Beyond the debate of its diagnostic significance, the clinical importance of irritability, anger, and aggression in youth with BD has been well established. In this review, the authors discuss evaluation and management strategies of irritability, anger, and aggression in youth with BD.
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9
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 242] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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10
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Roley-Roberts ME, Fristad MA. Moderators of Treatment for Pediatric Bipolar Spectrum Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:464-477. [DOI: 10.1080/15374416.2020.1772082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Mary A. Fristad
- Department of Psychiatry, The Ohio State University Wexner Medical Center
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11
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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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12
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L’éducation thérapeutique : un levier pour modifier les perceptions du trouble bipolaire chez les aidants familiaux. Encephale 2019; 45:239-244. [DOI: 10.1016/j.encep.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/29/2018] [Accepted: 11/11/2018] [Indexed: 12/20/2022]
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13
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Estrada-Prat X, Álvarez-Guerrico I, Batlle-Vila S, Camprodon-Rosanas E, Martín-López LM, Álvarez E, Romero S, Elices M, Pérez V. Sleep alterations in pediatric bipolar disorder versus attention deficit disorder. Psychiatry Res 2019; 275:39-45. [PMID: 30878855 DOI: 10.1016/j.psychres.2019.01.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 12/01/2022]
Abstract
Bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD) share numerous clinical features, which can make the differential diagnosis challenging. Studies conducted in adults suggest that patients with BD and ADHD have different sleep patterns. However, in pediatric populations, data on these potential differences are scant. The present preliminary study was conducted to identify potential differences in sleep alterations among youths diagnosed with BD or ADHD compared to healthy controls (HC). A total of 26 patients diagnosed with BD (n = 13) or ADHD (n = 13) were compared to 26 sex- and age-matched HC ([HCBD], n = 13, and [HCADHD], n = 13). All participants underwent polysomnography. The mean duration of stage N2 sleep was shorter in the BD group than in controls (HCBD). The BD group also had higher (non-significant) REM density (REMd) scores than controls while mean REMd scores were lower in the ADHD group versus controls. Compared to the ADHD group, the BD group presented a shorter N2 stage, a longer first REM sleep duration (R1), and greater REMd. According to our findings, these three variables-N2 stage, REMd, and R1-appear to differentiate patients with BD from those with ADHD and from HC.
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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; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain
| | - Ion Álvarez-Guerrico
- Neurology and Clinical Neurophysiology Department, Hospital del Mar, Barcelona, Spain
| | - Santiago Batlle-Vila
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain; Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions (INAD), Centre de Salut Mental Infantil i Juvenil (CSMIJ) Sant Martí-La Mina, Parc de Salut Mar, Barcelona, Spain
| | - 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
| | - Luís Miguel Martín-López
- INAD, CSMIJ Ciutat Vella, Parc de Salut Mar, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Enric Álvarez
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain; Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Soledad Romero
- Servei de Psiquiatria i Psicologia Infantil i Juvenil, 2017SGR88, Instituto de Neurociencias, Hospital Clínic i Provincial, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Matilde Elices
- Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - Víctor Pérez
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Spain; Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; INAD, Hospital del Mar, Barcelona, Spain
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14
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Cabral JM, Carvalho C, Castilho Freitas P, Pato C. Intervenções psicoeducativas dirigidas a familiares de indivíduos com transtorno bipolar. REVISTA DE ESTUDIOS E INVESTIGACIÓN EN PSICOLOGÍA Y EDUCACIÓN 2017. [DOI: 10.17979/reipe.2017.0.05.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Os familiares/cuidadores informais (CI) de indivíduos com transtornos mentais graves, como é o caso do Transtorno Bipolar (TB), estão sujeitos a um conjunto de dificuldades. Deste modo, é internacionalmente reconhecia a necessidade de se consolidar o apoio prestado a este tipo de CI. O presente estudo tem como objetivo analisar as características de intervenções destinadas a CI de indivíduos com TB, a partir de uma revisão sistemática da literatura.
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15
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Enhancing quality of life among adolescents with bipolar disorder: A randomized trial of two psychosocial interventions. J Affect Disord 2017; 219:201-208. [PMID: 28570966 PMCID: PMC5915675 DOI: 10.1016/j.jad.2017.04.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adolescents with bipolar disorder (BD) report lower quality of life (QoL) than adolescents with other psychiatric disorders. This study compared the efficacy of family-focused therapy for adolescents (FFT-A) plus pharmacotherapy to brief psychoeducation (enhanced care, or EC) plus pharmacotherapy on self-rated QoL in adolescents with BD over 2 years. METHODS Participants were 141 adolescents (mean age: 15.6±1.4yr) with BD I or II who had a mood episode in the previous 3 months. Adolescents and parents were randomly assigned to (1) FFT-A, given in 21 sessions in 9 months of psychoeducation, communication enhancement training, and problem-solving skills training, or (2) EC, given in 3 family psychoeducation sessions. Study psychiatrists provided patient participants with protocol-based pharmacotherapy for the duration of the study. QoL was assessed with The KINDLRQuestionnaire (Ravens-Sieberer and Bullinger, 1998) during active treatment (baseline to 9 months) and during a post-treatment follow-up (9-24 months). RESULTS The two treatment groups did not differ in overall QoL scores over 24 months. However, adolescents in FFT-A had greater improvements in quality of family relationships and physical well-being than participants in EC. For quality of friendships, the trajectory during active treatment favored EC, whereas the trajectory during post-treatment favored FFT-A. LIMITATIONS We were unable to standardize medication use or adherence over time. Quality of life was based on self-report rather than on observable functioning. CONCLUSIONS A short course of family psychoeducation and skills training may enhance relational functioning and health in adolescents with BD. The effects of different psychosocial interventions on peer relationships deserves further study.
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Walker DJ, DelBello MP, Landry J, D’Souza DN, Detke HC. Quality of life in children and adolescents with bipolar I depression treated with olanzapine/fluoxetine combination. Child Adolesc Psychiatry Ment Health 2017; 11:34. [PMID: 28706563 PMCID: PMC5506697 DOI: 10.1186/s13034-017-0170-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/18/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We examined the efficacy of olanzapine/fluoxetine combination (OFC) in improving health-related quality of life (QoL) in the treatment of bipolar depression in children and adolescents. METHODS Patients aged 10-17 years with bipolar I disorder, depressed episode, baseline children's depression rating scale-revised (CDRS-R) total score ≥40, Young Mania Rating Scale (YMRS) total score ≤15, and YMRS-item 1 ≤ 2 were randomized to OFC (6/25-12/50 mg/day olanzapine/fluoxetine; n = 170) or placebo (n = 85) for up to 8 weeks of double-blind treatment. Patients and parents completed the revised KINDL questionnaire for measuring health-related QoL in children and adolescents (KINDL-R) at baseline and endpoint. The mean change in CDRS-R total and item scores were used to compare improvement in symptomatology in patients taking OFC and placebo. Tests were 2-sided using a Type I error cutoff of 0.05, and no adjustments for multiple comparisons were made. RESULTS Baseline QoL as measured by the KINDL-R was substantially impaired relative to published norms for a healthy school-based sample. OFC-treated patients demonstrated an improvement over placebo at endpoint with respect to mean change from baseline in the patient-rated KINDL-R Self-esteem subscale score (p = 0.028), and in the parent KINDL-R ratings of emotional well-being (p = 0.020), Self-esteem (p = 0.030), and Family (p = 0.006). At endpoint, OFC-treated patients still had a lower QoL compared to the normative population. OFC showed significant improvement (p ≤ 0.05) versus placebo on the CDRS-R total score and on 7 of the 17 CDRS-R items. CONCLUSIONS Patients aged 10-17 years with an acute episode of bipolar depression and their parents reported greater improvements (parents noticed improvements in more areas than did their offspring) on some aspects of QoL when treated with OFC compared with placebo. However, after 8 weeks of treatment, KINDL-R endpoint scores remained lower than those of the, presumably healthy, control population. Clinical trial registration information A Study for Assessing Treatment of Patients Ages 10-17 with Bipolar Depression; http://www.clinicaltrials.gov; NCT00844857.
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Affiliation(s)
- Daniel J. Walker
- 0000 0000 2220 2544grid.417540.3Eli Lilly and Company, Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Melissa P. DelBello
- 0000 0001 2179 9593grid.24827.3bDivision of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - John Landry
- 0000 0004 0533 8801grid.418787.5Eli Lilly Canada Inc., Toronto, Canada
| | | | - Holland C. Detke
- 0000 0000 2220 2544grid.417540.3Eli Lilly and Company, Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN 46285 USA
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Bailly D. Interventions psychothérapiques dans le trouble bipolaire chez l’enfant et l’adolescent. Encephale 2017; 43:69-74. [DOI: 10.1016/j.encep.2016.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/22/2016] [Accepted: 03/08/2016] [Indexed: 10/21/2022]
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Vande Voort JL, Singh A, Bernardi J, Wall CA, Swintak CC, Schak KM, Jensen PS. Treatments and Services Provided to Children Diagnosed with Bipolar Disorder. Child Psychiatry Hum Dev 2016; 47:494-502. [PMID: 26323583 DOI: 10.1007/s10578-015-0582-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To better understand the types and quantity of mental health services and medication usage for youth diagnosed with bipolar disorder (BD) within an integrated healthcare system, medical records were reviewed from 2000 to 2011. Eighty-five youth diagnosed with BD were identified and healthcare services (medication and psychotherapy follow-up appointments, emergency room (ER) visits, admissions, phone contacts) and visit-related details (medication usage) were abstracted for 2 years after initial BD diagnosis. Despite complex medication regimens (91.7 and 81.2 % received mood stabilizers and antipsychotic agents, respectively), medication appointments were infrequent, averaging 1 visit every 2 months. Only 36 (42 %) of 85 youth were noted to receive psychotherapy services following BD diagnosis, also averaging 1 visit every 2 months. Most (58.8 %) patients needed one or more hospitalizations during the follow-up period; nearly half (48.2 %) had psychiatric ER visits. The relative lack of psychotherapy and infrequent follow-up visits suggests need for improvement to optimize healthcare delivery.
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Affiliation(s)
- Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Amandeep Singh
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julio Bernardi
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Christopher A Wall
- PrairieCare Medical Group, University of Minnesota Medical School Affiliate, Rochester, MN, USA
| | - Cosima C Swintak
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kathryn M Schak
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Marvin SE, Miklowitz DJ, O'Brien MP, Cannon TD. Family-focused therapy for individuals at clinical high risk for psychosis: treatment fidelity within a multisite randomized trial. Early Interv Psychiatry 2016; 10:137-43. [PMID: 24725329 PMCID: PMC4194178 DOI: 10.1111/eip.12144] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 02/28/2014] [Indexed: 11/30/2022]
Abstract
AIM Family psychoeducation is an effective adjunct to pharmacotherapy in delaying relapse among patients with schizophrenia and bipolar disorder. This study tested the treatment adherence and competence of newly trained clinicians to an adaptation of family-focused therapy for individuals at clinical high risk for psychosis (FFT-CHR). METHODS The sample included 103 youth or young adults (ages 12-30 years) who had attenuated positive symptoms of psychosis. Families participated in a randomized trial comparing two psychosocial interventions: FFT-CHR (18 sessions over 6 months) and enhanced care (EC; 3 sessions over 1 month). Following a 1.5-day training seminar, 24 clinicians from eight study sites received teleconference supervision in both treatment protocols for the 2-year study period. Treatment fidelity was rated with the 13-item Therapy Competence and Adherence Scales, Revised. RESULTS Supervisors classified 90% of treatment sessions as above acceptable fidelity thresholds (ratings of 5 or better on a 1-7 scale of overall fidelity). As expected, fidelity ratings indicated that FFT-CHR included a greater emphasis on communication and problem-solving skills training than EC, but ratings of non-specific clinician skills, such as maintaining rapport and appropriately pacing sessions, did not differ between conditions. Treatment fidelity was not related to the severity of symptoms or family conflict at study entry. CONCLUSIONS FFT-CHR can be administered with high levels of fidelity by clinicians who receive training and supervision. Future studies should examine whether there are more cost-effective methods for training, supervising and monitoring the fidelity of FFT-CHR.
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Affiliation(s)
- Sarah E Marvin
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA
| | - David J Miklowitz
- Department of Psychiatry, UCLA Semel Institute, Los Angeles, California, USA
| | - Mary P O'Brien
- Department of Psychiatry, UCLA Semel Institute, Los Angeles, California, USA
| | - Tyrone D Cannon
- Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA.,Department of Psychology, Psychiatry, and Human Genetics, University of California at Los Angeles, Los Angeles, California, USA
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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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Cognitive remediation: potential novel brain-based treatment for bipolar disorder in children and adolescents. CNS Spectr 2015; 20:382-90. [PMID: 26135596 PMCID: PMC4722947 DOI: 10.1017/s109285291500036x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bipolar disorder (BD) is among the most impairing psychiatric disorders affecting children and adolescents, despite our best psychopharmacological and psychotherapeutic treatments. Cognitive remediation, defined as a behavioral intervention designed to improve cognitive functions so as to reduce psychiatric illness, is an emerging brain-based treatment approach that has thus far not been studied in pediatric BD. The present article reviews the basic principles of cognitive remediation, describes what is known about cognitive remediation in psychiatric disorders, and delineates potential brain/behavior alterations implicated in pediatric BD that might be targets for cognitive remediation. Emerging data show that cognitive remediation may be useful in children and adults with schizophrenia, ADHD, and anxiety disorders, and in adults with BD. Potential targets for cognitive remediation in pediatric BD include face processing, response inhibition, frustration, and cognitive flexibility. Further study is warranted to determine if cognitive remediation for these targets, or others, may serve as a novel, brain-based treatment for pediatric BD.
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Abstract
Childhood mood disorders are associated with substantial impairment and risks for youth and their families. Identifying interventions that improve child and family functioning is essential for child, family, and public health. Several individual therapy modalities have been developed with historically little attention on family participation. However, with the accumulation of research demonstrating the roles family interactions can play in symptom presentation and course, interventions that include family involvement are garnering more attention and have demonstrated promising benefits for children with mood disorders. This article reviews evidence-based family-focused interventions for childhood mood disorders and provides examples of their implementation.
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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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Treatment development and feasibility study of family-focused treatment for adolescents with bipolar disorder and comorbid substance use disorders. J Psychiatr Pract 2014; 20:237-48. [PMID: 24847999 PMCID: PMC4142596 DOI: 10.1097/01.pra.0000450325.21791.7e] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comorbid substance use disorders (SUD) are associated with increased illness severity and functional impairment among adolescents with bipolar disorder (BD). Previous psychosocial treatment studies have excluded adolescents with both BD and SUD. Studies suggest that integrated interventions are optimal for adults with BD and SUD. METHODS We modified family-focused treatment for adolescents with BD (FFT-A) in order to explicitly target comorbid SUD (FFT-SUD). Ten adolescents with BD who had both SUD and an exacerbation of manic, depressed, or mixed symptoms within the last 3 months were enrolled. FFT-SUD was offered as an adjunct to pharmacotherapy, with a target of 21 sessions over 12 months of treatment. The FFT- SUD manual was iteratively modified to integrate a concurrent focus on SUD. RESULTS Six subjects completed a mid-treatment 6-month assessment (after a mean of 16 sessions was completed). Of the 10 subjects, 3 dropped out early (after ≤1 session); in the case of each of these subjects, the participating parent had active SUD. No other subjects in the study had a parent with active SUD. Preliminary findings suggested significant reductions in manic symptoms and depressive symptoms and improved global functioning in the subjects who completed 6 months of treatment. Reduction in cannabis use was modest and did not reach significance. Limitations. Limitations included a small sample, open treatment, concurrent medications, and no control group. CONCLUSIONS These preliminary findings suggest that FFT-SUD is a feasible intervention, particularly for youth without parental SUD. FFT-SUD may be effective in treating mood symptoms, particularly depression, despite modest reductions in substance use. Integrating motivation enhancing strategies may augment the effect of this intervention on substance use. Additional strategies, such as targeting parental substance use, may prevent early attrition.
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Peris TS, Piacentini J. Addressing Barriers to Change in the Treatment of Childhood Obsessive Compulsive Disorder. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2014. [DOI: 10.1007/s10942-014-0183-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Weinstein SM, West AE, Pavuluri M. Psychosocial intervention for pediatric bipolar disorder: current and future directions. Expert Rev Neurother 2013; 13:843-50. [PMID: 23898854 DOI: 10.1586/14737175.2013.811985] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pediatric bipolar disorder (PBD) affects approximately 2% of the population and disrupts mood regulation, psychosocial functioning and quality of life among affected youths and families. Given the significant psychosocial impairment and poor long-term prognosis associated with PBD, psychosocial intervention is considered to be an essential component of a multimodal treatment approach. This relatively young field of research has witnessed significant growth in the evidence base for psychosocial treatments targeting youths in the past decade, particularly family-based interventions grounded in a biopsychosocial framework. This article reviews existing empirically supported interventions for children and adolescents with PBD. Common elements of successful interventions are identified, and future research directions to address current limitations in the field and advance understanding of treatment for PBD are discussed.
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Affiliation(s)
- Sally M Weinstein
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, 1747 W Roosevelt Road, Room 155, Chicago, IL 60608, USA.
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Abstract
OBJECTIVES There is concern that treatment of serious mental illness in the United States declines precipitously following legal emancipation at age 18 years and transition from specialty youth clinical settings. We examined age transition effects on treatment utilization in a sample of youth with bipolar disorder. METHODS Youth with bipolar disorder (N=413) 7-18 years of age were assessed approximately twice per year (mean interval 8.2 months) for at least 4 years. Annual use of any individual, group, and family therapy, psychopharmacology visits, and hospitalization at each year of age, and monthly use from ages 17 through 19 years, were examined. The effect of age transition to 18 years on monthly visit probability was tested in the subsample with observed transitions (n=204). Putative sociodemographic moderators and the influence of clinical course were assessed. RESULTS Visit probabilities for the most common modalities-psychopharmacology, individual psychotherapy, and home-based care- generally fell from childhood to young adulthood. For example, the annual probability of at least one psychopharmacology visit was 97% at age 8, 75% at age 17, 60% at age 19, and 46% by age 22. Treatment probabilities fell in transitionage youth from age 17 through 19, but a specific transition effect at age 18 was not found. Declines did not vary based on sociodemographic characteristics and were not explained by changing severity of the bipolar illness or functioning. CONCLUSIONS Mental health treatment declined with age in this sample of youth with bipolar disorder, but reductions were not concentrated during or after the transition to age 18 years. Declines were unrelated to symptom severity or impairment.
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Ferreira GS, Moreira CRL, Kleinman A, Nader ECGP, Gomes BC, Teixeira AMA, Rocca CCA, Nicoletti M, Soares JC, Busatto GF, Lafer B, Caetano SC. Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder. Aust N Z J Psychiatry 2013; 47:1051-7. [PMID: 24108060 DOI: 10.1177/0004867413506754] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Children of parents with bipolar disorder (BD) are at heightened risk for developing mood and other psychiatric disorders. We proposed to evaluate the environment of families with at least one parent with BD type I (BDF) with affected offspring (aBDF) and unaffected offspring (uBDF) compared with control families without a history of DSM-IV Axis I disorder (CF). METHOD We used the Family Environment Scale (FES) to evaluate 47 BDF (aBDF + uBDF) and 30 CF. Parents were assessed through the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Diagnosis of the offspring was determined through the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) interview. RESULTS There were statistically significant differences between aBDF, uBDF and CF in cohesion (p = 0.003), intellectual-cultural orientation (p = 0.01), active-recreational orientation (p = 0.007), conflict (p = 0.001), control (p = 0.01), moral-religious emphasis (p = 0.01) and organization (p = 0.001). The aBDF showed higher levels of control (p = 0.02) when compared to the uBDF. CONCLUSIONS Families with a BD parent presented more dysfunctional interactions among members. Moreover, the presence of BD or other psychiatric disorders in the offspring of parents with BD is associated with higher levels of control. These results highlight the relevance of psychosocial interventions to improve resilience and family interactions.
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Affiliation(s)
- Guilherme S Ferreira
- 1Bipolar Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Van Meter AR, Henry DB, West AE. What goes up must come down: the burden of bipolar depression in youth. J Affect Disord 2013; 150:1048-54. [PMID: 23768529 PMCID: PMC3759628 DOI: 10.1016/j.jad.2013.05.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/17/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the pediatric bipolar disorder literature, mania has eclipsed depression as the mood state of most interest. Though depressive episodes tend to be more prevalent and persisting than manic episodes, research about the associated consequences is limited. The goal of the present study was to compare the influences of depressive and manic symptoms on domains of functioning in which youth with bipolar disorder often demonstrate deficits. METHOD Youth meeting DSM-IV-TR criteria for bipolar spectrum disorders (I, II, and NOS) between the ages of seven and 13 were recruited from a clinic in a large Midwestern city (N=54). Both parent and clinician report of manic and depressive symptoms were used in regression analyses to determine how each set of symptoms was related to child functioning. RESULTS Parent-rated child depression symptoms were associated with problem behaviors (p<0.05), and lower quality of life (p<0.001). Clinician-rated child depression was associated with greater psychiatric illness (p<0.05), lower child self-concept (p<0.001), lower quality of life (p<0.05), hopelessness (p<0.05), and suicidal ideation (p<0.05). Parent-rated mania was associated with better self-esteem (p<0.05) and physical wellbeing (p<0.05). Clinician-rated mania was associated with greater psychiatric illness (p<0.05) and physical wellbeing (p<0.05). LIMITATIONS The specific outcomes predicted by parent and clinician-rated symptoms vary. Though the overall story told--that bipolar depression is associated with significant impairment in youth--is consistent, further research is necessary to more fully understand the impact of each mood state. CONCLUSION Mania is undoubtedly destructive, but this study provides evidence to suggest that depression may be more deleterious to youths' psychosocial functioning and quality of life; more attention to understanding and ameliorating the effects of bipolar depression on youth is warranted.
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Affiliation(s)
- Anna R. Van Meter
- University of North Carolina at Chapel Hill, Department of Psychology
| | - David B. Henry
- University of Illinois at Chicago, Institute for Health Research and Policy
| | - Amy E. West
- University of Illinois at Chicago, Departments of Psychology and Psychiatry
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Young ME, Galvan T, Reidy BL, Pescosolido MF, Kim KL, Seymour K, Dickstein DP. Family functioning deficits in bipolar disorder and ADHD in youth. J Affect Disord 2013; 150:1096-102. [PMID: 23706879 PMCID: PMC3759554 DOI: 10.1016/j.jad.2013.04.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Rates of diagnosis and treatment for bipolar disorder (BD) in youth continue to rise. Researchers and clinicians experience difficulty differentiating between BD in youth and other conditions that are commonly comorbid or share similar clinical features with BD, especially attention-deficit/hyperactivity disorder (ADHD). Comparative studies of the phenomenology and psychosocial correlates of these conditions help to address this. Family functioning is an important topic for both BD and ADHD since both are associated with numerous family-related deficits. One previous study suggested that manic/hypomanic youths'family functioning differed from ADHD and typically developing control (TDC) groups. However, many family functioning studies with BD and ADHD youth have methodological limitations or fail to use comprehensive, validated measures. METHODS This investigation used adolescent report on the Family Assessment Device (FAD), based on the McMaster Model of family functioning. Youth were recruited in BD (n=30), ADHD (n=36), and TDC (n=41) groups. RESULTS Groups were similar on most demographic variables, but The TDC group scored somewhat higher than the others on IQ and socioeconomic status. FAD results indicated that BD and ADHD groups scored worse than TDC on the General Functioning and Roles scales of the FAD. In addition, the BD group showed impairment on the Problem Solving scale relative to TDC. LIMITATIONS sample size, lack of parent report, ADHD comorbidity in BD group. CONCLUSIONS Family functioning deficits distinguish both clinical groups from TDC, and problem-solving dysfunction may be specific to BD. These findings may apply to treatment models for both conditions.
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Affiliation(s)
- Matthew E. Young
- Pediatric Mood, Imaging and Neurodevelopment Program (Pedi-MIND), Emma Pendleton Bradley Hospital, East Providence, RI, USA
,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thania Galvan
- Pediatric Mood, Imaging and Neurodevelopment Program (Pedi-MIND), Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Brooke L. Reidy
- Pediatric Mood, Imaging and Neurodevelopment Program (Pedi-MIND), Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Matthew F. Pescosolido
- Pediatric Mood, Imaging and Neurodevelopment Program (Pedi-MIND), Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Kerri L. Kim
- Pediatric Mood, Imaging and Neurodevelopment Program (Pedi-MIND), Emma Pendleton Bradley Hospital, East Providence, RI, USA
,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Karen Seymour
- Pediatric Mood, Imaging and Neurodevelopment Program (Pedi-MIND), Emma Pendleton Bradley Hospital, East Providence, RI, USA
,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel P. Dickstein
- Pediatric Mood, Imaging and Neurodevelopment Program (Pedi-MIND), Emma Pendleton Bradley Hospital, East Providence, RI, USA
,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Fristad MA, MacPherson HA. Evidence-based psychosocial treatments for child and adolescent bipolar spectrum disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2013; 43:339-55. [PMID: 23927375 PMCID: PMC3844106 DOI: 10.1080/15374416.2013.822309] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pediatric bipolar spectrum disorders (BPSDs) are serious conditions associated with morbidity and mortality. Although most treatment research has examined pharmacotherapy for pediatric BPSDs, growing literature suggests that psychosocial interventions are also important to provide families with an understanding of symptoms, course, and treatment of BPSDs; teach youth and parents methods for coping with symptoms (e.g., problem solving, communication, emotion regulation, cognitive-behavioral skills); and prevent relapse. Thirteen psychosocial intervention trials for pediatric BPSDs were identified via a comprehensive literature search and evaluated according to the Task Force on the Promotion and Dissemination of Psychological Procedures guidelines. All interventions were examined adjunctive to pharmacotherapy and/or treatment as usual (TAU). No well-established or questionably efficacious treatments were identified. Family psychoeducation plus skill building was probably efficacious (i.e., Multi-Family Psychoeducational Psychotherapy, Family-Focused Treatment); cognitive-behavioral therapy (CBT) was possibly efficacious. Dialectical behavior therapy (DBT) and interpersonal and social rhythm therapy (IPSRT) were experimental. Limited research precluded subdivision of treatments by format and age. Only single- and multiple-family psychoeducation plus skill building and CBT were evaluated with children. Only single-family psychoeducation plus skill building and DBT, and individual (commonly with limited familial involvement) CBT and IPSRT were evaluated with adolescents. In conclusion, psychosocial interventions that involve families, psychoeducation, and skill building may offer added benefit to pharmacotherapy and/or other TAU. Limitations of current research include few outcome studies, small samples, and failure to use stringent control conditions or randomization. The review concludes with a discussion of mediators and moderators, recommendations for best practice, and suggestions for future research.
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Affiliation(s)
- Mary A. Fristad
- Departments of Psychiatry, Psychology, and Nutrition, The Ohio State University 1670 Upham Dr, Suite 460 Columbus, OH 46210-1250
| | - Heather A. MacPherson
- Departments of Psychiatry and Psychology, The Ohio State University 1670 Upham Dr, Suite 460 Columbus, OH 46210-1250 ()
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Boylan K, Macpherson HA, Fristad MA. Examination of disruptive behavior outcomes and moderation in a randomized psychotherapy trial for mood disorders. J Am Acad Child Adolesc Psychiatry 2013; 52:699-708. [PMID: 23800483 PMCID: PMC4326010 DOI: 10.1016/j.jaac.2013.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 04/19/2013] [Accepted: 04/29/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Multifamily psychoeducational psychotherapy (MF-PEP) is an efficacious treatment for children with mood disorders. Given the comorbidity between disruptive behaviors and mood disorders, this study examined associations between disruptive behaviors and impairment, impact of MF-PEP on disruptive behaviors, and whether disruptive behaviors affected treatment response of mood symptoms. METHOD Secondary analyses examined a randomized controlled trial of MF-PEP versus waitlist control (N = 165 children 8-11 years old with mood disorders and their parents). Comorbid behavioral diagnoses occurred in 97% of children. All participants continued treatment as usual. RESULTS Greater degree of disruptive behaviors was associated with worse mood symptoms and impairment. Between-group analyses examining outcome of disruptive behaviors were nonsignificant. Within-group analyses and between-group effect sizes suggested that MF-PEP was associated with decreases in attention-deficit/hyperactivity disorder (d = 0.39), oppositional defiant disorder (d = 0.30), and overall disruptive behavior symptoms (d = 0.30), but not conduct disorder symptoms. Baseline severity of disruptive behaviors did not affect treatment response of mood symptoms to MF-PEP. CONCLUSIONS MF-PEP is an effective intervention for children with mood disorders and provides some benefit for disruptive behaviors. Given that disruptive behavior severity does not affect children's ability to experience improved mood symptoms, MF-PEP may be an important early intervention for children with comorbid mood and disruptive behavior disorders. Subsequent intervention targeting behavioral symptoms after improvement in mood may be beneficial. Studies examining treatment sequencing for children with comorbid mood and disruptive behavior disorders are needed. Clinical trial registration information-Family psychoeducation for children with mood disorders; http://clinicaltrials.gov; NCT00050557.
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Affiliation(s)
- Khrista Boylan
- Department of Psychiatry and Behavioral Neuroscience, McMaster University, Hamilton, ON, Canada.
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Cosgrove VE, Roybal D, Chang KD. Bipolar depression in pediatric populations : epidemiology and management. Paediatr Drugs 2013; 15:83-91. [PMID: 23529869 DOI: 10.1007/s40272-013-0022-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Depression in children and adolescents with bipolar disorder is more commonly observed than mania or hypomania, and is associated with significant functional disability in multiple environmental realms. Optimal management of pediatric bipolar depression is often defined by its multimodal nature with emphasis on both psychopharmacological and psychosocial treatment. This article provides a brief overview of the epidemiology and clinical course of pediatric bipolar depression, a clinically-oriented guide to the evidence-based psychopharmacological and psychosocial management of bipolar depression in youth, and suggestions on how best to integrate medication and therapy. Recommended treatment for bipolar depression in pediatric populations usually includes both medication and psychosocial interventions given a paucity of double-blind, placebo-controlled psychopharmacological studies. Lithium and lamotrigine are feasible and tentatively efficacious options; however, treatment with quetiapine monotherapy may be no better than placebo. Furthermore, some youth may be at heightened risk for developing manic symptoms after treatment with selective serotonin reuptake inhibitors (SSRIs). Psychotherapy, either alone or adjunctively with medications, provides practitioners with a safe and feasible alternative. Interpersonal and Social Rhythm Therapy for Adolescents (IPSRT-A), Child- and Family-Focused Cognitive Behavioral Therapy (CFF-CBT), Dialectical Behavior Therapy for Adolescents (DBT-A), family psychoeducation, and Family Focused Therapy for Adolescents (FFT-A) are evidence-based treatments available to clinicians treating youth with bipolar depression.
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Affiliation(s)
- Victoria E Cosgrove
- Pediatric Bipolar Disorders Program, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, USA.
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Rocha TBM, Zeni CP, Caetano SC, Kieling C. Mood disorders in childhood and adolescence. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35 Suppl 1:S22-31. [DOI: 10.1590/1516-4446-2013-s106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Moreno DH, Bio DS, Petresco S, Petresco D, Gutt EK, Soeiro-de-Souza MG, Moreno RA. Burden of maternal bipolar disorder on at-risk offspring: a controlled study on family planning and maternal care. J Affect Disord 2012; 143:172-8. [PMID: 22877968 DOI: 10.1016/j.jad.2012.05.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 05/09/2012] [Accepted: 05/30/2012] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects. OBJECTIVE The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses. MATERIALS AND METHODS Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse. RESULTS BD mothers were less likely to have stable unions (45.5%; p<0.01) or to live with the biological father of their children (33.3%; p<0.01), but had higher educational level and higher rates of social security use/retirement. They also had fewer children and used less contraceptive methods than controls. Children of BD women had higher rates of neonatal anoxia, and reported more physical abuse (16.1%; p=0.02) than offspring of NPD mothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse. LIMITATIONS Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments. CONCLUSION This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation.
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Affiliation(s)
- Doris Hupfeld Moreno
- Mood Disorders Unit, Department and Institute of Psychiatry, Clinical Hospital, School of Medicine, University of Sao Paulo, Brazil.
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Van Meter AR, Youngstrom EA, Findling RL. Cyclothymic disorder: A critical review. Clin Psychol Rev 2012; 32:229-43. [DOI: 10.1016/j.cpr.2012.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/01/2012] [Accepted: 02/03/2012] [Indexed: 12/13/2022]
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Kang NR, Kwack YS. Clinical Course of Bipolar Disorder in Children and Adolescents. Soa Chongsonyon Chongsin Uihak 2012. [DOI: 10.5765/jkacap.2012.23.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Basco MR, Celis-de Hoyos CE. Biopsychosocial model of hypersexuality in adolescent girls with bipolar disorder: strategies for intervention. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2012; 25:42-50. [PMID: 22299806 DOI: 10.1111/j.1744-6171.2011.00312.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
TOPIC Engagement in high-risk behaviors, impaired judgment, and hypersexuality present unique health challenges to adolescent girls with bipolar disorder (BD). Behavioral management of sexuality does not routinely fall under the purview of psychiatric care, but requires preventive measures. PURPOSE This paper presents a biopsychosocial model of hypersexuality in girls with BD, describes factors that lead to high-risk sexual behaviors, and provides a framework for cognitive-behavioral intervention. SOURCES USED The study used a review of empirically based clinical and research literature. CONCLUSIONS Sexual health education, improved treatment adherence, symptom monitoring, interpersonal skills training, parental involvement, and clinician education can improve hypersexual behavior in girls with BD.
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Kaslow NJ, Broth MR, Smith CO, Collins MH. Family-based interventions for child and adolescent disorders. JOURNAL OF MARITAL AND FAMILY THERAPY 2012; 38:82-100. [PMID: 22283382 DOI: 10.1111/j.1752-0606.2011.00257.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes with a summary and directions for future research.
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Affiliation(s)
- Nadine J Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia 30303, USA.
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Mouchabac S. Les troubles de l’humeur bipolaire : rôle et souffrance des proches. Encephale 2011; 37:H29-31. [DOI: 10.1016/s0013-7006(11)70032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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González-Pinto A, Ruiz de Azúa S, Ibáñez B, Otero-Cuesta S, Castro-Fornieles J, Graell-Berna M, Ugarte A, Parellada M, Moreno D, Soutullo C, Baeza I, Arango C. Can positive family factors be protective against the development of psychosis? Psychiatry Res 2011; 186:28-33. [PMID: 20627207 DOI: 10.1016/j.psychres.2010.05.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 04/26/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
Genetic and environmental factors are both involved in the aetiology of psychotic disorders. The aim of this study was to assess if positive and negative environmental factors, together with psychotic family antecedents, are associated with the recent development of psychosis. We also investigated the interactions between family history of psychosis and positive and negative family environment. The sample comprised 110 children and adolescents, who had suffered a first psychotic episode and 98 healthy controls. All subjects were interviewed about their socioeconomic status, family history of psychosis and family environment (Family Environment Scale, FES). Early onset psychosis was significantly associated with a family history of psychosis. Family environment was perceived as more negative and less positive among patients than among controls. A negative family environment increased the risk of psychosis independently of the family history of psychosis. However, there was a significant protective effect of a positive family environment for persons with a family history of psychosis. This effect was not seen in subjects without a family history of psychosis. Therefore, our results support the importance of considering both family history of psychosis and family environment in the early stages of psychosis.
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Affiliation(s)
- Ana González-Pinto
- Biomedical Research Center in Mental Health Net (CIBERSAM), Hospital Santiago Apóstol, Vitoria, Spain, University of the Basque Country.
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Washburn JJ, West AE, Heil JA. Treatment of Pediatric Bipolar Disorder: A Review. MINERVA PSICHIATRICA 2011; 52:21-35. [PMID: 21822352 PMCID: PMC3150503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM: To review the diagnosis and the pharmacologic and psychosocial interventions for pediatric bipolar disorder (PBD). METHODS: A comprehensive literature review of studies discussing the diagnosis and treatment of PBD was conducted. RESULTS: A context for understanding controversies and difficulties in the diagnosis of PBD is provided. An evidence-based assessment protocol for PBD is reviewed. The evidence for the following three categories of pharmacologic interventions are reviewed: Lithium, antiepileptics, and second generation antipsychotics. Algorithms for medication decisions are briefly reviewed. Existing psychosocial treatments and the evidence for those treatments are also reviewed. CONCLUSION: Despite recent developments in understanding the phenomenology of PBD and in identifying pharmacologic and psychosocial interventions, critical gaps remain.
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Affiliation(s)
- Jason J. Washburn
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences
- Alexian Brothers Behavioral Health Hospital
| | - Amy E. West
- University of Illinois Chicago, Department of Psychiatry
| | - Jennifer A. Heil
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences
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Richardson T. Psychosocial Interventions for Bipolar Disorder: A Review of Recent Research. JOURNAL OF MEDICAL SCIENCES 2010. [DOI: 10.3923/jms.2010.143.152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fristad MA. Development of emotion regulation in children of bipolar parents: Treatment implications. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2010. [DOI: 10.1111/j.1468-2850.2010.01210.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE The literature on bipolar in children and adolescents was reviewed to provide an update for clinicians. REVIEW PROCESS Literature of particular relevance to evidence-based practice was selected for critical review. OUTCOMES An up-to-date overview of clinical features, epidemiology, prognosis, aetiology, assessment and intervention was provided. CONCLUSIONS Bipolar disorder in children and adolescence is a relatively common, multifactorially determined and recurring problem which persists into adulthood. Psychometrically robust screening questionnaires and structured interviews facilitate reliable assessment. Multimodal chronic care programmes involving medication (notably lithium) and family-oriented psychotherapy are currently the treatment of choice.
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Affiliation(s)
- Alan Carr
- University College Dublin, Belfield, Ireland.
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Hlastala SA, Kotler JS, McClellan JM, McCauley EA. Interpersonal and social rhythm therapy for adolescents with bipolar disorder: treatment development and results from an open trial. Depress Anxiety 2010; 27:457-64. [PMID: 20186968 PMCID: PMC4318681 DOI: 10.1002/da.20668] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In adolescents and adults, bipolar disorder (BD) is associated with significant morbidity, mortality, and impairment in psychosocial and occupational functioning. IPSRT is an empirically supported adjunctive psychotherapy for adults with bipolar disorder, which has been shown to help delay relapse, speed recovery from a bipolar depressive episode, and increase occupational and psychosocial functioning in adults with BD. This study is designed to describe the adolescent-specific developmental adaptations made to IPSRT (i.e., IPSRT-A) and to report the results from an open trial of IPSRT-A with 12 adolescents with a bipolar spectrum disorder. METHOD Interpersonal and Social Rhythm Therapy was adapted to be developmentally relevant to adolescents with bipolar disorder. Twelve adolescents (mean age 16.5+/-1.3 years) diagnosed with a bipolar spectrum disorder participated in 16-18 sessions of adjunctive IPSRT-A over 20 weeks. Manic, depressive, and general symptoms and global functioning were measured at baseline, monthly during treatment, and at post-treatment. Adolescent satisfaction with treatment was also measured. RESULTS Feasibility and acceptability of IPSRT-A were high; 11/12 participants completed treatment, 97% of sessions were attended, and adolescent-rated satisfaction scores were high. IPSRT-A participants experienced significant decreases in manic, depressive, and general psychiatric symptoms over the 20 weeks of treatment. Participants' global functioning increased significantly as well. Effect sizes ranged from medium-large to large. CONCLUSIONS IPSRT-A appears to be a promising adjunctive treatment for adolescents with bipolar disorder. A current randomized controlled trial is underway to examine effects of adjunctive IPSRT-A on psychiatric symptoms and psychosocial functioning.
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Affiliation(s)
- Stefanie A. Hlastala
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, and the Department of Child and Adolescent Psychiatry, Seattle Children’s Hospital, Seattle, WA
| | - Julie S. Kotler
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA
| | - Jon M. McClellan
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, and the Department of Child and Adolescent Psychiatry, Seattle Children’s Hospital, Seattle, WA
| | - Elizabeth A. McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, and the Department of Child and Adolescent Psychiatry, Seattle Children’s Hospital, Seattle, WA
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Parens E, Johnston J. Controversies concerning the diagnosis and treatment of bipolar disorder in children. Child Adolesc Psychiatry Ment Health 2010; 4:9. [PMID: 20219111 PMCID: PMC2846895 DOI: 10.1186/1753-2000-4-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 03/10/2010] [Indexed: 11/22/2022] Open
Abstract
This commentary grows out of an interdisciplinary workshop focused on controversies surrounding the diagnosis and treatment of bipolar disorder (BP) in children. Although debate about the occurrence and frequency of BP in children is more than 50 years old, it increased in the mid 1990s when researchers adapted the DSM account of bipolar symptoms to diagnose children. We offer a brief history of the debate from the mid 90s through the present, ending with current efforts to distinguish between a small number of children whose behaviors closely fit DSM criteria for BP, and a significantly larger number of children who have been receiving a BP diagnosis but whose behaviors do not closely fit those criteria. We agree with one emerging approach, which gives part or all of that larger number of children a new diagnosis called Severe Mood Dysregulation or Temper Dysregulation Disorder with Dysphoria.Three major concerns arose about interpreting the DSM criteria more loosely in children than in adults. If clinicians offer a treatment for disorder A, but the patient has disorder B, treatment may be compromised. Because DSM's diagnostic labels are meant to facilitate research, when they are applied inconsistently, such research is compromised. And because BP has a strong genetic component, the label can distract attention from the family or social context.Once a BP diagnosis is made, concerns remain regarding the primary, pharmacological mode of treatment: data supporting the efficacy of the often complex regimens are weak and side effects can be significant. However, more than is widely appreciated, data do support the efficacy of the psychosocial treatments that should accompany pharmacotherapy. Physicians, educators, and families should adopt a multimodal approach, which focuses as much on the child's context as on her body. If physicians are to fulfill their ethical obligation to facilitate truly informed consent, they must be forthcoming with families about the relevant uncertainties and complexities.
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Affiliation(s)
- Erik Parens
- The Hastings Center, Garrison, NY 10524, USA.
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