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Resendes T, Ellenbogen MA, Oldehinkel AJ. Family dysfunction, stressful life events, and mental health problems across development in the offspring of parents with an affective disorder. J Child Psychol Psychiatry 2024. [PMID: 38682166 DOI: 10.1111/jcpp.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well-known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD. METHODS As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self-Report, Family Assessment Device, and an in-house measure, respectively. RESULTS Multi-group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood. CONCLUSIONS OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high-risk youth.
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Affiliation(s)
- Tiffany Resendes
- Department of Psychology (SP-219), Concordia University, Montreal, QC, Canada
| | - Mark A Ellenbogen
- Department of Psychology (SP-219), Concordia University, Montreal, QC, Canada
| | - Albertine J Oldehinkel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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2
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Helmink FGL, Vandeleur CL, Preisig M, Gunput STG, Hillegers MHJ, Mesman E. Functional outcomes across development in offspring of parents with bipolar disorder. J Affect Disord 2023; 340:490-505. [PMID: 37467795 DOI: 10.1016/j.jad.2023.07.072] [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] [Received: 09/06/2022] [Revised: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Whereas the risk and course of psychopathology in offspring of parents with bipolar disorder (BD) have been the primary focus of high-risk offspring studies to date, functional outcomes have not been given much attention. We present a systematic review of functional outcomes and quality of life (QoL) across development in offspring of parents with BD and aim to explore the role of offspring psychopathology in these outcomes. METHOD We searched Embase, MEDLINE, PsycINFO, Web of Science, Cochrane Central, and Google Scholar from inception to June 24, 2022, for studies referring to functional outcomes (global, social, academic or occupational) or QoL in offspring of parents with BD. RESULTS From the 6470 records identified, 39 studies were retained (global = 17; social = 17; school = 16; occupational = 3; QoL = 5), including 13 studies that examined multiple domains. For all domains, high heterogeneity was found in study methods and quality. Only 56 % of studies adjusted for offspring psychopathology, impeding interpretation. Global and social functioning generally seemed to be impaired among older offspring (>16 years). Academic performance appeared to be unaffected. School behavior, occupational functioning, and QoL showed mixed results. Offspring psychopathology is associated with social functioning, but the relationship of offspring psychopathology with other domains is less clear. CONCLUSION Studies on functional outcome in offspring of parents with BD show predominantly mixed results. Inconsistent adjustment of psychopathology and age limits conclusive interpretation. Functional outcomes should be prioritized as research topics in high-risk studies and the potential associations between familial risk status, offspring psychopathology, and age may inform prevention strategies.
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Affiliation(s)
- Fleur G L Helmink
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Caroline L Vandeleur
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Esther Mesman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
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3
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Resendes T, Serravalle L, Iacono V, Ellenbogen MA. Reduced parenting stress following a prevention program decreases internalizing and externalizing symptoms in the offspring of parents with bipolar disorder. Int J Bipolar Disord 2023; 11:10. [PMID: 36849568 PMCID: PMC9971411 DOI: 10.1186/s40345-022-00284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/22/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Offspring of parents with bipolar disorder (OBD) are at risk for developing mental disorders, and the literature suggests that parenting stress may represent an important risk factor linking parental psychopathology to offspring psychopathology. We aimed to investigate whether improvements in parenting stress mediated the relationship between participation in a prevention program and offspring internalizing and externalizing symptoms at follow-up. METHODS Families having a parent with BD (N = 25) underwent a 12-week prevention program. Assessments were conducted at pre-intervention, post-intervention, and at 3- and 6-month follow-ups. Families of parents with no affective disorders (i.e., control families) served as a comparison sample (N = 28). The Reducing Unwanted Stress in the Home (RUSH) program aimed to teach communication, problem-solving, and organization skills to improve the rearing environment. Measures included the Parenting Stress Index-4th Edition, the Behaviour Assessment Scales for Children-2nd Edition, and the UCLA Life Stress Interview. RESULTS Families having a parent with BD reported more parenting stress at pre-intervention, and more change across time, than control families. Improvements in parenting stress mediated the relationship between participation in the intervention and reduced offspring internalizing and externalizing symptoms. While families having a parent with BD reported more chronic interpersonal stress at pre-intervention, no intervention effects were found. CONCLUSIONS The findings demonstrate that a preventative intervention targeting parenting stress in families may serve to prevent the development of mental disorders in at-risk children.
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Affiliation(s)
- Tiffany Resendes
- Centre for Research in Human Development, Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, QC, H4B 1R6, Canada
| | - Lisa Serravalle
- Centre for Research in Human Development, Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, QC, H4B 1R6, Canada
| | - Vanessa Iacono
- Centre for Research in Human Development, Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, QC, H4B 1R6, Canada
| | - Mark A Ellenbogen
- Centre for Research in Human Development, Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, QC, H4B 1R6, Canada.
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4
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Kavitha RR, Kamalam S, Rajkumar RP. Effectiveness of Family-Focused Nurse-led Intervention on Functional Improvement of Patients with Bipolar Disorder at a Tertiary Hospital in South India: A Randomized Controlled Trial. Indian J Psychol Med 2022; 44:152-159. [PMID: 35655970 PMCID: PMC9120984 DOI: 10.1177/02537176211060557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bipolar affective disorder (BPAD) is a chronic, episodic illness that can create problems and disruptions in the social, occupational, and family functioning of a client. Families are frequently most affected by their bipolar member and have a sense of helplessness to fix bipolar symptoms. The current study aimed to assess the effectiveness of Family-focused Nursing Interventions (FFNI) on functional improvement in the sample of symptomatic bipolar affective disorder clients. METHOD In this experimental study, 149 patients with BPAD were interviewed along with family members through the consecutive sampling technique from the inpatient ward. Varying block randomization was used to allocate the patients to the control and experimental groups. After obtaining ethical clearance, the study was registered under the Clinical trail registry India (CTRI). Baseline sociodemographic and clinical variables, and the functional levels, were assessed using Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool and Functional Assessment Short Test. The control group (74) received routine treatment; the experimental group (75) received routine treatment along with FFNI in seven sessions, and posttest was conducted at discharge, one-month, and at two-month follow-up at OPD. The collected data were analyzed using SPSS 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows Version 20.0, Armonk, NY: IBM Corp.), independent sample t-test, analysis of variance, and Pearson correlation used. A P-value of less than 0.05 was considered as a statistically significant result. RESULTS At the end of the study, 149 clients completed the treatment and follow-up. Both the groups were comparable at baseline in demography as well as clinical variables. There was significant improvement in the functional level after FFNI. The total score of LIFE-RIFT and the Functional Assessment Short Test score were significantly lower in the experimental group than the control group with P = 0.001. CONCLUSION The current study concluded that adjuvant to routine treatment FFNI will improve the functional ability of the client along with routine psychiatric treatment for BPAD.
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Affiliation(s)
- Rajendran Rangasamy Kavitha
- Dept. of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Ravi Philip Rajkumar
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
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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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Del Favero E, Montemagni C, Bozzatello P, Brasso C, Riccardi C, Rocca P. The Management of Prodromal Symptoms of Bipolar Disorder: Available Options and Future Perspectives. ACTA ACUST UNITED AC 2021; 57:medicina57060545. [PMID: 34071356 PMCID: PMC8229021 DOI: 10.3390/medicina57060545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022]
Abstract
The onset of prodromal symptoms in subjects who are at familial or clinical risk for bipolar disorder could be considered as an important alarm bell for the development of the disease and should be carefully detected. The management of prodromes in bipolar high-risk patients appears to be an important means of prevention; nevertheless, at the moment, there aren’t clear and widely shared treatment indications. The aim of this review is to summarize the available treatment options (pharmacological, psychosocial and nutraceutical) for the management of prodromal symptoms in subjects who are at familial or clinical risk for bipolar disorder.
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Affiliation(s)
- Elisa Del Favero
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
| | - Cristiana Montemagni
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza, via Cherasco 11, 10126 Turin, Italy;
| | - Paola Bozzatello
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
| | - Claudio Brasso
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
| | - Cecilia Riccardi
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
| | - Paola Rocca
- Dipartimento di Neuroscienze “Rita Levi Montalcini”, Università degli Studi di Torino, Via Cherasco 11, 10126 Turin, Italy; (E.D.F.); (P.B.); (C.B.); (C.R.)
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza, via Cherasco 11, 10126 Turin, Italy;
- Correspondence:
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8
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Serravalle L, Iacono V, Wilson AL, Orlando MA, Tsekova V, Ellenbogen MA. Improved Parent-Child Interactions Predict Reduced Internalizing Symptoms Among the Offspring of Parents with Bipolar Disorder Undergoing a Prevention Program: A Proof-of-Concept Study. Res Child Adolesc Psychopathol 2021; 49:817-830. [PMID: 33544277 DOI: 10.1007/s10802-020-00743-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
The offspring of parents with bipolar disorder (OBD) exhibit elevated rates of psychopathology. However, preventative interventions are lacking. Using a quasi-experimental design with an assessment-only control group, we examined if a 12-week program (entitled Reducing Unwanted Stress in the Home, RUSH) decreases internalizing and externalizing symptoms in the OBD (aged 6-11 years) via intervention-related gains in parent-child interaction quality. Participants consisted of 55 offspring (26 OBD; 29 controls) and their parents. Assessments were conducted at four time points up to six months following the end of the RUSH program, during which parent and teacher ratings of child symptoms, and parent-child interaction quality (parental positivity and negativity, and dyadic mutuality) were measured. Multilevel modelling showed improved parental positivity and negativity, and dyadic mutuality among target dyads immediately and six months post-intervention. For the bootstrapping mediation analyses, intervention-related change in parental negativity fully mediated the relations between having participated in the RUSH program and lower parent-reported internalizing problems among the OBD six months later. These data provide evidence of the efficacy of the RUSH program for OBD who exhibited improved interactions with their parents post-intervention. Further investigation via a randomized controlled trial is warranted.
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Affiliation(s)
- Lisa Serravalle
- Centre for Research in Human Development, Concordia University, Québec, Montréal, Canada
| | - Vanessa Iacono
- Centre for Research in Human Development, Concordia University, Québec, Montréal, Canada
| | - Alexa L Wilson
- Department of Psychology, University of Montreal, Québec, Montréal, Canada
| | - Mark Anthony Orlando
- Centre for Research in Human Development, Concordia University, Québec, Montréal, Canada
| | - Virginia Tsekova
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Mark A Ellenbogen
- Centre for Research in Human Development, Concordia University, Québec, Montréal, Canada.
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9
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Early intervention for people at high risk of developing bipolar disorder: a systematic review of clinical trials. Lancet Psychiatry 2021; 8:64-75. [PMID: 32857954 DOI: 10.1016/s2215-0366(20)30188-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/23/2022]
Abstract
Early intervention approaches are built on the premise of preventing disability, burden, and cognitive sequelae caused by bipolar disorder. The objective of this systematic review was to characterise the effectiveness of all the available psychological and pharmacological treatments for early intervention in people at high risk of developing bipolar disorder. The study was registered with PROSPERO (CRD42019133420). We did a systematic search to identify studies published in ten databases up to March 27, 2020. Randomised controlled trials and cohort studies that assessed the effect of pharmacological or psychological interventions in people at high risk of developing bipolar disorder were included. Studies of first episodes of mania were excluded. Eligible papers were assessed for quality and data were extracted. The primary outcomes were change in manic and depressive symptoms from baseline to endpoint. Of the 2856 citations retrieved by our search, 16 studies were included; five evaluated pharmacotherapeutic strategies (three randomised controlled trials and two open-label studies), ten assessed psychotherapeutic strategies (four randomised controlled trials and six open-label studies), and one randomised controlled trial assessed combination therapy; these 16 trials included a total of 755 participants at high risk of developing bipolar disorder. Quality assessment indicated fair to good quality for open-label studies, and a high risk of bias in four randomised controlled trials. Among the pharmacotherapeutic interventions, there is preliminary support for the efficacy of aripiprazole in reducing mood symptoms in people at high risk of developing bipolar disorder. Psychological interventions were effective for various outcomes. There was substantial methodological heterogeneity across studies. This systematic review underscores the need for multicentre, prospective, methodologically homogeneous studies evaluating conversion to bipolar disorder as an outcome measure.
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10
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Leopold K, Bauer M, Bechdolf A, Correll CU, Holtmann M, Juckel G, Lambert M, Meyer TD, Pfeiffer S, Kittel-Schneider S, Reif A, Stamm TJ, Rottmann-Wolf M, Mathiebe J, Kellmann EL, Ritter P, Krüger-Özgürdal S, Karow A, Sondergeld LM, Roessner V, Sauer C, Pfennig A. Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study. Bipolar Disord 2020; 22:517-529. [PMID: 32112496 DOI: 10.1111/bdi.12894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. METHOD In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30 years were randomized to 14 weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. RESULTS Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs. CONCLUSIONS Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Cologne, University Cologne, Köln, Germany
| | - Christoph U Correll
- Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Center for Psychiatric Neuroscience Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Psychiatry, Recognition and Prevention (RAP) Program, The Zucker Hillside Hospital, Long Island, USA.,Department of Child and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr-University, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, Houston, TX, USA
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Maren Rottmann-Wolf
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Josephine Mathiebe
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva L Kellmann
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lene-Marie Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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11
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Pfennig A, Leopold K, Martini J, Boehme A, Lambert M, Stamm T, Bermpohl F, Reif A, Kittel-Schneider S, Juckel G, Fallgatter AJ, Kircher T, Jansen A, Pfeiffer S, Berndt C, Rottmann-Wolf M, Sauer C, Ritter P, Correll CU, Bechdolf A, Falkenberg I, Bauer M. Improving early recognition and intervention in people at increased risk for the development of bipolar disorder: study protocol of a prospective-longitudinal, naturalistic cohort study (Early-BipoLife). Int J Bipolar Disord 2020; 8:22. [PMID: 32607662 PMCID: PMC7326843 DOI: 10.1186/s40345-020-00183-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Bipolar disorders (BD) belong to the most severe mental disorders, characterized by an early onset and recurrent, severe episodes or a chronic course with poor psychosocial functioning in a proportion of patients. Many patients with BD experience substantial symptomatology months or even years before full BD manifestation. Adequate diagnosis and treatment is often delayed, which is associated with a worse outcome. This study aims to prospectively evaluate and improve early recognition and intervention strategies for persons at-risk for BD. Methods Early-BipoLife is a prospective-longitudinal cohort study of 1419 participants (aged 15–35 years) with at least five waves of assessment over a period of at least 2 years (baseline, 6, 12, 18 and 24 months). A research consortium of ten university and teaching hospitals across Germany conducts this study. The following risk groups (RGs) were recruited: RG I: help-seeking youth and young adults consulting early recognition centres/facilities presenting ≥ 1 of the proposed risk factors for BD, RG II: in-/outpatients with unipolar depressive syndrome, and RG III: in-/outpatients with attention-deficit/hyperactivity disorder (ADHD). The reference cohort was selected from the German representative IMAGEN cohort. Over the study period, the natural course of risk and resilience factors, early symptoms of BD and changes of symptom severity (including conversion to manifest BD) are observed. Psychometric properties of recently developed, structured instruments on potential risk factors for conversion to BD and subsyndromal symptomatology (Bipolar Prodrome Symptom Scale, Bipolar at-risk criteria, EPIbipolar) and biomarkers that potentially improve prediction are investigated. Moreover, actual treatment recommendations are monitored in the participating specialized services and compared to recently postulated clinical categorization and treatment guidance in the field of early BD. Discussion Findings from this study will contribute to an improved knowledge about the natural course of BD, from the onset of first noticeable symptoms (precursors) to fully developed BD, and about mechanisms of conversion from subthreshold to manifest BD. Moreover, these generated data will provide information for the development of evidence-based guidelines for early-targeted detection and preventive intervention for people at risk for BD.
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Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anne Boehme
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL-University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Andreas J Fallgatter
- Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Maren Rottmann-Wolf
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christoph U Correll
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, NY, USA.,Department of Child- and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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12
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Miklowitz DJ, Schneck CD, Walshaw PD, Singh MK, Sullivan AE, Suddath RL, Forgey Borlik M, Sugar CA, Chang KD. Effects of Family-Focused Therapy vs Enhanced Usual Care for Symptomatic Youths at High Risk for Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:455-463. [PMID: 31940011 PMCID: PMC6990706 DOI: 10.1001/jamapsychiatry.2019.4520] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Behavioral high-risk phenotypes predict the onset of bipolar disorder among youths who have parents with bipolar disorder. Few studies have examined whether early intervention delays new mood episodes in high-risk youths. OBJECTIVE To determine whether family-focused therapy (FFT) for high-risk youths is more effective than standard psychoeducation in hastening recovery and delaying emergence of mood episodes during the 1 to 4 years after an active period of mood symptoms. DESIGN, SETTINGS, AND PARTICIPANTS This multisite randomized clinical trial included referred youths (aged 9-17 years) with major depressive disorder or unspecified (subthreshold) bipolar disorder, active mood symptoms, and at least 1 first- or second-degree relative with bipolar disorder I or II. Recruitment started from October 6, 2011, and ended on September 15, 2016. Independent evaluators interviewed participants every 4 to 6 months to measure symptoms for up to 4 years. Data analysis was performed from March 13 to November 3, 2019. INTERVENTIONS High-risk youths and parents were randomly allocated to FFT (12 sessions in 4 months of psychoeducation, communication training, and problem-solving skills training; n = 61) or enhanced care (6 sessions in 4 months of family and individual psychoeducation; n = 66). Youths could receive medication management in either condition. MAIN OUTCOMES AND MEASURES The coprimary outcomes, derived using weekly psychiatric status ratings, were time to recovery from prerandomization symptoms and time to a prospectively observed mood (depressive, manic, or hypomanic) episode after recovery. Secondary outcomes were time to conversion to bipolar disorder I or II and longitudinal symptom trajectories. RESULTS All 127 participants (82 [64.6%] female; mean [SD] age, 13.2 [2.6] years) were followed up for a median of 98 weeks (range, 0-255 weeks). No differences were detected between treatments in time to recovery from pretreatment symptoms. High-risk youths in the FFT group had longer intervals from recovery to the emergence of the next mood episode (χ2 = 5.44; P = .02; hazard ratio, 0.55; 95% CI, 0.48-0.92;), and from randomization to the next mood episode (χ2 = 4.44; P = .03; hazard ratio, 0.59; 95% CI, 0.35-0.97) than youths in enhanced care. Specifically, FFT was associated with longer intervals to depressive episodes (log-rank χ2 = 6.24; P = .01; hazard ratio, 0.53; 95% CI, 0.31-0.88) but did not differ from enhanced care in time to manic or hypomanic episodes, conversions to bipolar disorder, or symptom trajectories. CONCLUSIONS AND RELEVANCE Family skills-training for youths at high risk for bipolar disorder is associated with longer times between mood episodes. Clarifying the relationship between changes in family functioning and changes in the course of high-risk syndromes merits future investigation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01483391.
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Affiliation(s)
- David J. Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles
| | | | - Patricia D. Walshaw
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles
| | - Manpreet K. Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Aimee E. Sullivan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver
| | - Robert L. Suddath
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles
| | - Marcy Forgey Borlik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles
| | - Catherine A. Sugar
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles,Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles
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13
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Stapp EK, Musci RJ, Fullerton JM, Glowinski AL, McInnis M, Mitchell PB, Hulvershorn LA, Ghaziuddin N, Roberts GM, Merikangas KR, Nurnberger JI, Wilcox HC. Patterns and predictors of family environment among adolescents at high and low risk for familial bipolar disorder. J Psychiatr Res 2019; 114:153-160. [PMID: 31078786 PMCID: PMC6546513 DOI: 10.1016/j.jpsychires.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 01/31/2023]
Abstract
Children's perceptions are important to understanding family environment in the bipolar disorder (BD) high-risk context. Our objectives were to empirically derive patterns of offspring-perceived family environment, and to test the association of family environment with maternal or paternal BD accounting for offspring BD and demographic characteristics. Participants aged 12-21 years (266 offspring of a parent with BD, 175 offspring of a parent with no psychiatric history) were recruited in the US and Australia. We modeled family environment using latent profile analysis based on offspring reports on the Conflict Behavior Questionnaire, Family Adaptability and Cohesion Evaluation Scales, and Home Environment Interview for Children. Parent diagnoses were based on the Diagnostic Interview for Genetic Studies and offspring diagnoses were based on the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Latent class regression was used to test associations of diagnosis and family environment. Two-thirds of all offspring perceived well-functioning family environment, characterized by nurturance, flexibility, and low conflict. Two 'conflict classes' perceived family environments low in flexibility and cohesion, with substantial separation based on high conflict with the father (High Paternal Conflict), or very high conflict and rigidity and low warmth with the mother (High Maternal Conflict). Maternal BD was associated with offspring perceiving High Maternal Conflict (OR 2.8, p = 0.025). Clinical care and psychosocial supports for mothers with BD should address family functioning, with attention to offspring perceptions of their wellbeing. More research is needed on the effect of paternal BD on offspring and family dynamics.
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Affiliation(s)
- Emma K. Stapp
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,National Institute of Mental Health, Bethesda, MD, USA
| | | | - Janice M. Fullerton
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia & School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Anne L. Glowinski
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Melvin McInnis
- Department of Psychiatry and Depression Center, University of Michigan, Ann Arbor, MI
| | - Philip B. Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia and Black Dog Institute, Sydney, NSW, Australia
| | - Leslie A. Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Neera Ghaziuddin
- Department of Psychiatry and Depression Center, University of Michigan, Ann Arbor, MI
| | - Gloria M.P. Roberts
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia and Black Dog Institute, Sydney, NSW, Australia
| | | | - John I. Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA,Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Holly C. Wilcox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Johns Hopkins School of Medicine, Baltimore, MD, USA
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14
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Perich T, Mitchell PB. Psychological interventions for young people at risk for bipolar disorder: A systematic review. J Affect Disord 2019; 252:84-91. [PMID: 30981060 DOI: 10.1016/j.jad.2019.04.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/08/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Several studies have recently been conducted that have explored the benefits of psychological interventions in reducing symptomatology or improving outcomes in young people at-risk of developing bipolar disorder. The aim of this review was to explore if such interventions reduce current psychiatric symptoms and prevent the development of new symptoms. METHODS A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Databases searched were MEDLINE, EMBASE, PsychInfo, CINAHL and SCOPUS from January 1990 until August 2018. The inclusion criteria were young people aged under 30 years with a family history of bipolar disorder and any empirical studies that contained a psychological or psychoeducation intervention. RESULTS A total of 7 articles (N = 138, 55 males) were included (mean age ranged from 12 to 15 years). Interventions conducted included Family Focussed Therapy, Interpersonal and Social Rhythm Therapy, and Mindfulness-based Cognitive Therapy for Children. Significant results were found in some studies, depending on the sample's initial symptoms, with reduced time to relapse and reduced symptoms of anxiety, depression and hypo/mania being found. LIMITATIONS No studies have explored if interventions may delay the time to onset of first hypo/manic episodes and only two randomised controlled trials were identified. CONCLUSIONS Some significant results were noted with lower symptoms of anxiety, depression and hypo/mania being found in some studies. It is currently unclear if psychological interventions may prevent the development of bipolar disorder or other psychiatric symptoms over time; further longitudinal studies are required.
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Affiliation(s)
- Tania Perich
- Clinical and Health Psychology Research Initiative (CaHPRI), School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797 Penrith, NSW 2751, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia
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15
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Davison J, Scott J. Should we intervene at stage 0? A qualitative study of attitudes of asymptomatic youth at increased risk of developing bipolar disorders and parents with established disease. Early Interv Psychiatry 2018; 12:1112-1119. [PMID: 28188672 DOI: 10.1111/eip.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/08/2016] [Accepted: 11/13/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies of potential interventions for asymptomatic individuals at risk of severe mental disorders (ie, clinical stage 0) have focused on genetic counselling or the views of adults with established disease. No study has interviewed youth at risk of bipolar disorders (BD). METHODS Qualitative analysis of interviews with asymptomatic adolescent offspring of adults with BD (OSBD = 7) and unrelated parents with bipolar disorders (PBD = 6) to examine manifest and latent themes in the dialogue. RESULTS Core themes in both groups were ignorance regarding the magnitude of risk of BD onset in offspring and greater concerns for the health of other family members than for oneself. Parents expressed anxieties in coping with the uncertainty about whether their children would inherit BD and their desire to reduce this risk was partly driven by guilt and their sense of responsibility; PBD favoured the introduction of specialized clinical OSBD services. In contrast, the priority for OSBD was advice on coping with a parent with BD; OSBD favoured access to generic non-clinical peer group support, which they perceived as less stigmatizing than specialist services. CONCLUSION The study highlights that youth at risk of BD should be allowed to express their ideas on what interventions they believe are likely to be most beneficial for them, as their views may differ from other advocates who are routinely consulted, such as PBD. A noteworthy finding was that OSBD thought that being included in the clinical dialogue about their parents' BD would decrease rather than increase their stress levels.
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Affiliation(s)
- Jo Davison
- Newcastle Early Intervention in Psychosis Service, NTW NHS Trust, Newcastle, UK
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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16
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Conroy S, Francis M, Hulvershorn LA. Identifying and treating the prodromal phases of bipolar disorder and schizophrenia. ACTA ACUST UNITED AC 2018; 5:113-128. [PMID: 30364516 DOI: 10.1007/s40501-018-0138-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Purpose of review The goal of this paper is to review recent research on the identification and treatment of prodromal periods that precede bipolar and psychotic disorders. We also sought to provide information about current best clinical practices for prodromal youth. Recent findings Research in the areas of identifying prodromal periods has rapidly advanced. Calculators that can predict risk are now available for use during both bipolar and psychotic disorder prodromes. Cognitive behavior therapies have emerged as the gold standard psychosocial interventions for the psychosis prodrome, while several other types of therapies hold promise for treatment during the bipolar prodrome. Due to safety and efficacy concerns, pharmacologic treatments are not currently recommended during either prodromal period. Summary While additional research is needed to develop useful clinical tools to screen and diagnose during prodromal phases, existing literature has identified constellations of symptoms that can be reliably identified in research settings. Specialized psychotherapies are currently recommended to treat prodromal symptoms in clinical settings. They may also be useful to curtail future episodes, although further research is needed.
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Affiliation(s)
- Susan Conroy
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael Francis
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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17
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McAulay C, Mond J, Touyz S. Early intervention for bipolar disorder in adolescents: A psychosocial perspective. Early Interv Psychiatry 2018; 12:286-291. [PMID: 28836352 DOI: 10.1111/eip.12474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 01/28/2023]
Abstract
AIM Early intervention in bipolar disorder (BD) has received increasing attention in recent years. The identification of risk factors has improved, but researchers continue to struggle to find an effective treatment once the illness has become established. The aetiology of BD and feasibility of early intervention present a challenge, making it difficult to decide who to target, as well as how. METHODS This essay seeks to address the lack of guidance for managing patients with a possible emerging bipolar illness, by presenting a rough roadmap to psychological care. The psychological techniques currently showing the most potential for this challenging group are reviewed. Markers of risk and supplementary clinical targets, such as anxiety and sleep disruption, are also discussed. RESULTS While research in this group remains in its infancy, various avenues of enquiry show promise, such as family-based approaches, CBT that targets features beyond the core illness, psychoeducation, and interventions that consider physical health. However, clearer pathways for establishing the course and stage of the illness are required to inform the intensity and type of treatment. CONCLUSION It is argued that treating early, indistinct symptoms of psychological distress, that may or may not signify prodromal BD, is valuable beyond its utility as an early intervention tool, as it has the capacity to improve help-seeking behaviour, quality of life and the likelihood of functional recovery in those who go on to develop the illness as adults.
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Affiliation(s)
- Claire McAulay
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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18
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Findling RL, Youngstrom EA, Rowles BM, Deyling E, Lingler J, Stansbrey RJ, McVoy M, Lytle S, Calabrese JR, McNamara NK. A Double-Blind and Placebo-Controlled Trial of Aripiprazole in Symptomatic Youths at Genetic High Risk for Bipolar Disorder. J Child Adolesc Psychopharmacol 2017; 27:864-874. [PMID: 28759262 DOI: 10.1089/cap.2016.0160] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine if acute treatment with aripiprazole (APZ) would be superior to treatment with placebo in reducing dysfunctional symptoms of elevated mood and/or irritability in symptomatic children and adolescents at familial high risk for bipolar disorder (BPD) whose mood episodes occur spontaneously. These are patients we have previously referred to as suffering from "cyclotaxia." METHODS This was single-site, randomized, double-blind, placebo-controlled outpatient clinical trial in which youths aged 5-17 years who met diagnostic criteria for either cyclothymic disorder (CYC) or BPD not otherwise specified (BP-NOS) were randomly assigned to receive either APZ or placebo. Eligible participants had at least one parent with BPD, another first- or second-degree relative afflicted with a mood disorder, and also had not responded to psychotherapy. Treatment with APZ was initiated at a dose of approximately 0.1 mg/kg/day and could be increased by approximately 0.05 mg/kg/day at each study visit. Patients were seen weekly for 4 weeks and then every other week thereafter for 12 weeks. The primary outcome measure was mean change from baseline on Young Mania Rating Scale (YMRS) total score. RESULTS A total of 59 patients (30 APZ, 29 placebo) aged 11.8 (SD = 2.7) years were randomized and returned for at least one postbaseline assessment. The mean total daily doses of active APZ and placebo were 7.1 mg (SD = 3.7) and 7.4 mg (SD = 4.2), respectively. At the 12-week time point, APZ was superior to placebo on the primary outcome measure (p < 0.005). Most adverse events were mild and transient in nature. There was a significant difference in weight gain from baseline between patients who received APZ (2.3 kg [SD = 3.3]) and those who received placebo (0.7 kg [SD = 1.8]). CONCLUSION This double-blind trial found that APZ was significantly more efficacious than placebo in reducing symptoms of mania in children and adolescents with cyclotaxia.
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Affiliation(s)
- Robert L Findling
- 1 Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University and The Kennedy Krieger Institute , Baltimore, Maryland
| | - Eric A Youngstrom
- 2 Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Brieana M Rowles
- 3 Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Elizabeth Deyling
- 4 Department of Psychiatry, Case Western Reserve University , Cleveland, Ohio
| | - Jacqui Lingler
- 4 Department of Psychiatry, Case Western Reserve University , Cleveland, Ohio
| | - Robert J Stansbrey
- 4 Department of Psychiatry, Case Western Reserve University , Cleveland, Ohio
| | - Molly McVoy
- 4 Department of Psychiatry, Case Western Reserve University , Cleveland, Ohio
| | - Sarah Lytle
- 4 Department of Psychiatry, Case Western Reserve University , Cleveland, Ohio
| | - Joseph R Calabrese
- 4 Department of Psychiatry, Case Western Reserve University , Cleveland, Ohio
| | - Nora K McNamara
- 4 Department of Psychiatry, Case Western Reserve University , Cleveland, Ohio
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19
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Malhi GS, Morris G, Hamilton A, Outhred T, Mannie Z. Is "early intervention" in bipolar disorder what it claims to be? Bipolar Disord 2017; 19:627-636. [PMID: 29268003 DOI: 10.1111/bdi.12576] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The notion of early intervention is understandably appealing for conditions such as bipolar disorder (BD), a chronic life-long illness that increases risk of suicide and diminishes quality of life. It is purported that intervening early in the course of the illness with suitable interventions could substantially alter the trajectory of BD and improve outcomes. However, while there are obvious benefits to the prompt commencement of treatment, it is important to consider the gaps in our understanding regarding the aetiopathogenesis of bipolar disorder-upon which the paradigm of early intervention is predicated. METHODS A literature search was undertaken using recognized search engines: PubMed, PsycINFO Medline, and Scopus, along with auxiliary manual searches. RESULTS This review first examines how the unpredictable nature of BD creates substantial difficulties when determining an optimal therapeutic target for early intervention. Second, the challenges with identifying appropriate populations and apposite times for early intervention strategies is discussed. Finally, the risks associated with intervening early are examined, highlighting the potential harmful effects of initiating medication. CONCLUSION Early intervention for BD is a potentially useful strategy that warrants investigation, but until the emergence and trajectory of the illness are definitive, and a clear view of key targets is achieved, a more conservative approach to treating nascent BD and its antecedent symptoms is needed.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
| | - Grace Morris
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
| | - Amber Hamilton
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
| | - Zola Mannie
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
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20
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Zalpuri I, Singh MK. Treatment of psychiatric symptoms among offspring of parents with bipolar disorder. ACTA ACUST UNITED AC 2017; 4:341-356. [PMID: 29503793 DOI: 10.1007/s40501-017-0126-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose of Review Bipolar disorder is highly familial and has a protracted and diagnostically confusing prodrome. This review critically evaluates recently published literature relevant to the treatment of psychiatric symptoms in high-risk offspring of parents with Bipolar Disorder. Recent Findings Non-pharmacological treatment options including psychotherapy, resilience promotion through good sleep, diet, and exercise hygiene, and omega-3 fatty acid supplementation are important first line interventions for high-risk offspring. There has been some success in treating this population with open-label trials with mood stabilizers and atypical antipsychotics; however, these results have not been replicated in randomized controlled trails. Summary Despite some progress in early identification of symptoms in offspring of parents with Bipolar Disorder, there is scarce evidence supporting the treatment of these high-risk youth to prevent psychiatric symptoms from progressing to threshold bipolar or other psychiatric disorders. There is a need for prospective and randomized trials and research that identifies reliable biomarkers to individualize treatments for these youth.
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Affiliation(s)
- Isheeta Zalpuri
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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21
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Schneck CD, Chang KD, Singh MK, DelBello MP, Miklowitz DJ. A Pharmacologic Algorithm for Youth Who Are at High Risk for Bipolar Disorder. J Child Adolesc Psychopharmacol 2017; 27:796-805. [PMID: 28731778 PMCID: PMC5689113 DOI: 10.1089/cap.2017.0035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Depression and brief periods of manic symptoms are linked to a significant risk of progression to bipolar disorder (BD) in children who have a first-degree relative with BD I or II. However, little evidence exists to guide the pharmacologic management of children with these high-risk phenotypes. We propose a pharmacological treatment algorithm for high-risk youth and present results on its use in a study of children with a first-degree relative with BD. METHODS Subjects were 40 youth (mean 12.7 years, range 9-17 years) who had (1) a first-degree relative with lifetime history of BD I or II, (2) DSM-IV-TR diagnoses of BD not otherwise specified, major depressive disorder or cyclothymic disorder, and (3) active symptoms of depression, mania, or hypomania. Participants and their families were enrolled in a randomized trial examining the effects of two psychosocial interventions on the 1-year course of mood disorder. At study intake, participants received a psychiatric evaluation and were offered medications or had existing medications optimized to decrease symptom severity. During the 1-year study, psychiatrists treated participants using a medication algorithm to treat depressive or manic symptoms as well as comorbid anxiety and/or attention-deficit/hyperactivity disorder. RESULTS At study entry, 25 of 40 (62.5%) of the participants were taking at least one psychiatric medication. At 1 year, nearly an identical proportion were taking medications (22 of 35, 63%). Independent ratings indicated that in 84.7% of the study visits, physicians maintained adherence to the algorithm. No patients experienced antidepressant- or stimulant-induced mania during the study. CONCLUSIONS An algorithmic approach to pharmacologic interventions may aid in the management of youth (i.e., age <18) at high risk for BD. Future studies should compare outcomes in high-risk patients receiving algorithm-prescribed treatment versus those receiving treatment as usual. CLINICAL TRIAL REGISTRATION INFORMATION Early Family-Focused Treatment for Youth at Risk for Bipolar Disorder; www.clinicaltrials.gov/ ; NCT00943085.
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Affiliation(s)
- Christopher D. Schneck
- Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, University of Colorado School of Medicine, Aurora, Colorado
| | - Kiki D. Chang
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Manpreet K. Singh
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Melissa P. DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David J. Miklowitz
- Child and Adolescent Mood Disorders Program, UCLA Semel Institute, Los Angeles, California
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22
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Shaw P, Blumberg HP. Timely Research in Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder. Biol Psychiatry 2017; 82:621-622. [PMID: 28965559 PMCID: PMC5937925 DOI: 10.1016/j.biopsych.2017.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Philip Shaw
- National Human Genome Research Institute and the National Institute of Mental Health, Bethesda, Maryland
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23
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Fries GR, Quevedo J, Zeni CP, Kazimi IF, Zunta-Soares G, Spiker DE, Bowden CL, Walss-Bass C, Soares JC. Integrated transcriptome and methylome analysis in youth at high risk for bipolar disorder: a preliminary analysis. Transl Psychiatry 2017; 7:e1059. [PMID: 28291257 PMCID: PMC5416675 DOI: 10.1038/tp.2017.32] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/20/2017] [Accepted: 01/18/2017] [Indexed: 12/19/2022] Open
Abstract
First-degree relatives of patients with bipolar disorder (BD), particularly their offspring, have a higher risk of developing BD and other mental illnesses than the general population. However, the biological mechanisms underlying this increased risk are still unknown, particularly because most of the studies so far have been conducted in chronically ill adults and not in unaffected youth at high risk. In this preliminary study we analyzed genome-wide expression and methylation levels in peripheral blood mononuclear cells from children and adolescents from three matched groups: BD patients, unaffected offspring of bipolar parents (high risk) and controls (low risk). By integrating gene expression and DNA methylation and comparing the lists of differentially expressed genes and differentially methylated probes between groups, we were able to identify 43 risk genes that discriminate patients and high-risk youth from controls. Pathway analysis showed an enrichment of the glucocorticoid receptor (GR) pathway with the genes MED1, HSPA1L, GTF2A1 and TAF15, which might underlie the previously reported role of stress response in the risk for BD in vulnerable populations. Cell-based assays indicate a GR hyporesponsiveness in cells from adult BD patients compared to controls and suggest that these GR-related genes can be modulated by DNA methylation, which poses the theoretical possibility of manipulating their expression as a means to counteract the familial risk presented by those subjects. Although preliminary, our results suggest the utility of peripheral measures in the identification of biomarkers of risk in high-risk populations and further emphasize the potential role of stress and DNA methylation in the risk for BD in youth.
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Affiliation(s)
- G R Fries
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - J Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA,Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA,Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - C P Zeni
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - I F Kazimi
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - G Zunta-Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - D E Spiker
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - C L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - C Walss-Bass
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA,Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA,Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBSB 5102A, Houston, TX 77054, USA. E-mail:
| | - J C Soares
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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24
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Ritter PS, Bermpohl F, Gruber O, Hautzinger M, Jansen A, Juckel G, Kircher T, Lambert M, Mulert C, Pfennig A, Reif A, Rienhoff O, Schulze TG, Severus E, Stamm T, Bauer M. Aims and structure of the German Research Consortium BipoLife for the study of bipolar disorder. Int J Bipolar Disord 2016; 4:26. [PMID: 27873290 PMCID: PMC5118379 DOI: 10.1186/s40345-016-0066-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/28/2016] [Indexed: 11/28/2022] Open
Abstract
Background Bipolar disorder is a severe and heterogeneous mental disorder. Despite great advances in neuroscience over the past decades, the precise causative mechanisms at the transmitter, cellular or network level have so far not been unraveled. As a result, individual treatment decisions cannot be tailor-made and the uncertain prognosis is based on clinical characteristics alone. Although a subpopulation of patients have an excellent response to pharmacological monotherapy, other subpopulations have been less well served by the medical system and therefore require more focused attention. In particular individuals at high risk of bipolar disorder, young patients in the early stages of bipolar disorder, patients with an unstable highly relapsing course and patients with acute suicidal ideation have been identified as those in need. Structure A research consortium of ten universities across Germany has therefore implemented a 4 year research agenda including three randomized controlled trials, one epidemiological trial and one cross-sectional trial to address these areas of unmet needs. The topics under investigation will be the improvement of early recognition, specific psychotherapy, and smartphones as an aid for early episode detection and biomarkers of lithium response. A subset of patients will be investigated utilizing neuroimaging (fMRI), neurophysiology (EEG), and biomaterials (genomics, transcriptomics). Conclusions This article aims to outline the rationale, design, and methods of these individual studies.
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Affiliation(s)
- Philipp S Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Felix Bermpohl
- Department of Psychiatry, Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5, 10115, Berlin, Germany
| | - Oliver Gruber
- Department of Psychiatry, Ruprecht-Karls-University Heidelberg, Voßstr. 4, 69115, Heidelberg, Germany
| | - Martin Hautzinger
- Department of Psychology Clinical Psychology and Psychotherapy, Eberhard Karls University, Schleichstr. 4, 72076, Tübingen, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.,Marburg & Core-Unit Brain Imaging, Philipps-University Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.,Marburg & Core-Unit Brain Imaging, Philipps-University Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Psychosis Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Psychosis Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Otto Rienhoff
- Department of Medical Informatics, University of Göttingen, Göttingen, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), Medical Center of the University of Munich, Munich, Germany
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Thomas Stamm
- Department of Psychiatry, Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5, 10115, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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25
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Abstract
Bipolar disorder in youth substantially impairs behavior, family, and social functioning and interferes with developmental course. There is increasing interest in defining a bipolar prodrome similar to that reported in early-onset psychosis that will allow for earlier intervention and reduction in overall morbidity and mortality. Several lines of research have addressed this important issue including studies of offspring of bipolar parents, high-risk cohorts, and longitudinal follow-up of subjects with major depressive disorder (MDD), ADHD, and bipolar spectrum disorder. The development and validation of bipolar prodrome rating scales also shows promise. Recent attempts to intervene at earlier stages of bipolar disorder have led to some positive outcomes. However, a controversy remains concerning the identification and management of the earliest symptoms. Further research is needed to fully validate a bipolar prodrome and to determine the optimal course of action at various stages of illness.
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26
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Benarous X, Consoli A, Milhiet V, Cohen D. Early interventions for youths at high risk for bipolar disorder: a developmental approach. Eur Child Adolesc Psychiatry 2016; 25:217-33. [PMID: 26395448 DOI: 10.1007/s00787-015-0773-6] [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: 01/20/2015] [Indexed: 10/23/2022]
Abstract
In recent decades, ongoing research programmes on primary prevention and early identification of bipolar disorder (BD) have been developed. The aim of this article is to review the principal forms of evidence that support preventive interventions for BD in children and adolescents and the main challenges associated with these programmes. We performed a literature review of the main computerised databases (MEDLINE, PUBMED) and a manual search of the literature relevant to prospective and retrospective studies of prodromal symptoms, premorbid stages, risk factors, and early intervention programmes for BD. Genetic and environmental risk factors of BD were identified. Most of the algorithms used to measure the risk of developing BD and the early interventions programmes focused on the familial risk. The prodromal signs varied greatly and were age dependent. During adolescence, depressive episodes associated with genetic or environmental risk factors predicted the onset of hypomanic/manic episodes over subsequent years. In prepubertal children, the lack of specificity of clinical markers and difficulties in mood assessment were seen as impeding preventive interventions at these ages. Despite encouraging results, biomarkers have not thus far been sufficiently validated in youth samples to serve as screening tools for prevention. Additional longitudinal studies in youths at high risk of developing BD should include repeated measures of putative biomarkers. Staging models have been developed as an integrative approach to specify the individual level of risk based on clinical (e.g. prodromal symptoms and familial history of BD) and non-clinical (e.g. biomarkers and neuroimaging) data. However, there is still a lack of empirically validated studies that measure the benefits of using these models to design preventive intervention programmes.
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Affiliation(s)
- Xavier Benarous
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France.
| | - Angèle Consoli
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France.,INSERM U-669, PSIGIAM, Paris, France
| | - Vanessa Milhiet
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75013, Paris, France.,CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Paris, France
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27
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28
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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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29
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Vallarino M, Henry C, Etain B, Gehue LJ, Macneil C, Scott EM, Barbato A, Conus P, Hlastala SA, Fristad M, Miklowitz DJ, Scott J. An evidence map of psychosocial interventions for the earliest stages of bipolar disorder. Lancet Psychiatry 2015; 2:548-63. [PMID: 26360451 PMCID: PMC4629930 DOI: 10.1016/s2215-0366(15)00156-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/22/2015] [Accepted: 03/24/2015] [Indexed: 12/27/2022]
Abstract
Depression, schizophrenia, and bipolar disorder are three of the four most burdensome problems in people aged under 25 years. In psychosis and depression, psychological interventions are effective, low-risk, and high-benefit approaches for patients at high risk of first-episode or early-onset disorders. We review the use of psychological interventions for early-stage bipolar disorder in patients aged 15-25 years. Because previous systematic reviews had struggled to identify information about this emerging sphere of research, we used evidence mapping to help us identify the extent, distribution, and methodological quality of evidence because the gold standard approaches were only slightly informative or appropriate. This strategy identified 29 studies in three target groups: ten studies in populations at high risk for bipolar disorder, five studies in patients with a first episode, and 14 studies in patients with early-onset bipolar disorder. Of the 20 completed studies, eight studies were randomised trials, but only two had sample sizes of more than 100 individuals. The main interventions used were family, cognitive behavioural, and interpersonal therapies. Only behavioural family therapies were tested across all of our three target groups. Although the available interventions were well adapted to the level of maturity and social environment of young people, few interventions target specific developmental psychological or physiological processes (eg, ruminative response style or delayed sleep phase), or offer detailed strategies for the management of substance use or physical health.
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Affiliation(s)
- Martine Vallarino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Chantal Henry
- Faculté de médecine, Université Paris Est, Créteil, France; Pôle de Psychiatrie, APHP, Hôpital H Mondor-A Chenevier, Créteil, France
| | - Bruno Etain
- Faculté de médecine, Université Paris Est, Créteil, France; Pôle de Psychiatrie, APHP, Hôpital H Mondor-A Chenevier, Créteil, France
| | - Lillian J Gehue
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Craig Macneil
- Early Psychosis Prevention & Intervention Centre, Orygen Youth Health, Melbourne, VIC, Australia
| | - Elizabeth M Scott
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia; School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Angelo Barbato
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy; IRIS Postgraduate Psychotherapy School, Milan, Italy
| | - Philippe Conus
- Département Universitaire de Psychiatrie CHUV, Service de Psychiatrie Générale, Lausanne University, Clinique de Cery, Prilly, Lausanne, Switzerland
| | - Stefanie A Hlastala
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of Washington, WA, Seattle, USA
| | - Mary Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, and Ohio State University Harding Hospital, Columbus, OH, USA
| | - David J Miklowitz
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Centre for Affective Disorders, IPPN, King's College, London, UK.
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Abstract
Bipolar disorder (BPD) essentially has its onset during adolescence and early adulthood. It has the capacity to be highly disruptive, dislocating individuals from their normal developmental trajectory and potentially causing significant long-term co-morbidity and chronicity. At a societal level the burden created is greater than schizophrenia. This is not helped by the very substantial delays in its diagnosis and appropriate treatment. Thus, there is a clear rationale for intervening earlier and at a younger age. However, the field of early intervention in BPD is in its infancy. One approach that conceptually provides a basis for early intervention is the Clinical Staging Model (used widely in general medicine). This article outlines how this model helps in an understanding of the emerging stages of BPD. It also summarises the interventions that might be appropriately introduced if a person progresses from an early to a late stage of the illness. Early intervention has a well-established record in psychotic disorders. If it can be realised for BPDs, then it may hold out hope of better outcomes for the next generation of young people at risk.
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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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32
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Garrett AS, Miklowitz DJ, Howe ME, Singh MK, Acquaye TK, Hawkey CG, Glover GH, Reiss AL, Chang KD. Changes in brain activation following psychotherapy for youth with mood dysregulation at familial risk for bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:215-20. [PMID: 25283342 PMCID: PMC4258439 DOI: 10.1016/j.pnpbp.2014.09.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/28/2014] [Accepted: 09/23/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Psychotherapy for youth with mood dysregulation can help stabilize mood and improve functioning, but the neural mechanisms of this improvement are not known. In this study we investigated the changes in brain activation underlying improvement in mood symptoms. METHODS Twenty-four subjects (ages 13-17) participated: 12 patients with clinically significant symptoms of depression and/or mania, and 12 healthy comparison subjects (HC) matched for age and sex. All subjects completed functional magnetic resonance imaging while viewing facial expressions. The patients then received up to 4 months of psychotherapy and were rescanned at end of treatment. Whole brain differences between patient and control groups were assessed with a voxel-wise analysis. Changes in activation from pre- to post-treatment within the patient group were tested for correlation with changes in mood symptoms. RESULTS At baseline the patient group had hypoactivation in the dorsolateral prefrontal cortex (DLPFC) and hyperactivation in the posterior cingulate cortex compared to the HC group. Between pre- and post-treatment activation increased in the DLPFC and decreased in the amygdala. Increases in DLPFC activation were significantly correlated with improvement in mania symptoms. DISCUSSION Enhancement of frontal executive control brain regions may underlie improvement in mood dysregulation in pediatric patients at familial risk for bipolar disorder.
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Affiliation(s)
- Amy S. Garrett
- Stanford University School of Medicine, Department of Psychiatry,Center for Interdisciplinary Brain Sciences Research,Pediatric Bipolar Disorders Program
| | | | - Meghan E. Howe
- Stanford University School of Medicine, Department of Psychiatry,Pediatric Bipolar Disorders Program
| | - Manpreet K. Singh
- Stanford University School of Medicine, Department of Psychiatry,Pediatric Bipolar Disorders Program
| | - Tenah K. Acquaye
- Stanford University School of Medicine, Department of Psychiatry,Pediatric Bipolar Disorders Program
| | | | | | - Allan L. Reiss
- Stanford University School of Medicine, Department of Psychiatry,Center for Interdisciplinary Brain Sciences Research
| | - Kiki D. Chang
- Stanford University School of Medicine, Department of Psychiatry,Pediatric Bipolar Disorders Program
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33
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Strawn JR, Adler CM, McNamara RK, Welge JA, Bitter SM, Mills NP, Barzman DH, Cerullo MA, Chang KD, Strakowski SM, DelBello MP. Antidepressant tolerability in anxious and depressed youth at high risk for bipolar disorder: a prospective naturalistic treatment study. Bipolar Disord 2014; 16:523-30. [PMID: 23937313 PMCID: PMC9435372 DOI: 10.1111/bdi.12113] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 05/08/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Depressive and anxiety disorders are common in youth who are at risk for bipolar disorder (i.e., youth who have at least one parent with bipolar disorder) and antidepressants are commonly prescribed as treatment. However, there are few data regarding the safety and tolerability of antidepressants in this population. Therefore, we sought to prospectively examine the effects of these medications in children and adolescents who are diagnosed with depressive or anxiety disorders and have a parent with bipolar I disorder. METHODS Youth aged 9-20 years, with at least one parent with bipolar I disorder [high risk (HR)], were recruited (n = 118) and assessed using semi-structured diagnostic interviews. Participants were prospectively evaluated using a modified version of the Longitudinal Interval Follow-up Evaluation to assess changes in affective and anxiety symptoms and were treated naturalistically. RESULTS Over the course of 43-227 weeks (mean duration of follow-up: 106 ± 55 weeks), 21% (n = 25) of youth had antidepressant exposure and, of these, 57% (n = 12) had an adverse reaction (e.g., irritability, aggression, impulsivity, or hyperactivity) that led to antidepressant discontinuation. Those patients who experienced an adverse reaction were significantly younger than those who did not (p = 0.02) and discontinuation of antidepressant therapy secondary to an adverse event occurred at an average of 16.7 ± 17.4 weeks (median: 11 weeks, range: 2-57 weeks). Cox proportional hazard analyses yielded a hazard ratio of 0.725 (p = 0.03), suggesting that there is a 27% decrease in the likelihood of an antidepressant-related adverse event leading to discontinuation with each one-year increase in age. CONCLUSIONS Antidepressant medications may be poorly tolerated in youth with a familial risk for developing mania. Controlled studies further assessing treatments for depression and anxiety in HR youth are urgently needed.
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Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
| | - Caleb M Adler
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
| | - Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
| | - Jeffrey A Welge
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
| | - Samantha M Bitter
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
| | - Neil P Mills
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
| | - Drew H Barzman
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
| | - Kiki D Chang
- Department of Psychiatry and Behavioral Sciences, Pediatric Bipolar Disorders Program, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen M Strakowski
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, Division of Bipolar Disorders Research, University of Cincinnati, College of Medicine
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Correll CU, Hauser M, Penzner JB, Auther AM, Kafantaris V, Saito E, Olvet D, Carrión RE, Birmaher B, Chang KD, DelBello MP, Singh MK, Pavuluri M, Cornblatt BA. Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode. Bipolar Disord 2014; 16:478-92. [PMID: 24597782 PMCID: PMC4186919 DOI: 10.1111/bdi.12194] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/10/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of the present study was to systematically evaluate the prodrome to mania in youth. METHODS New-onset/worsening symptoms/signs of ≥ moderate severity preceding first mania were systematically assessed in 52 youth (16.2 ± 2.8 years) with a research diagnosis of bipolar I disorder (BD-I). Youth and/or caregivers underwent semi-structured interviews, using the Bipolar Prodrome Symptom Scale-Retrospective. RESULTS The mania prodrome was reported to start gradually in most youth (88.5%), with either slow (59.6%) or rapid (28.8%) deterioration, while a rapid-onset-and-deterioration prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring ≥ 3 symptoms, lasted 10.3 ± 14.4 months [95% confidence interval (CI): 6.3-14.4], being present for ≥ 4 months in 65.4% of subjects. Among prodromal symptoms reported in ≥ 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy/activity: 50.0%), two were nonspecific (decreased school/work functioning: 65.4%, mood swings/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic/depressive (inattention: 51.9%). A decreasing number of youth had ≥ 1 (84.6%), ≥ 2 (48.1%), or ≥ 3 (26.9%) 'specific' subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5 ± 14.9 months (95% CI: 5.0-14.0), 3.5 ± 3.5 months (95% CI: 2.0-4.9), and 3.0 ± 3.2 months (95% CI: 1.0-5.0) for ≥ 1, ≥ 2, or ≥ 3 specific symptoms, respectively. CONCLUSIONS In youth with BD-I, a relatively long, predominantly slow-onset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help to increase chances for early detection and prevention before full mania.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Hofstra North Shore-LIJ School of Medicine, Hempstead, NY; The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
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Bechdolf A, Ratheesh A, Cotton SM, Nelson B, Chanen AM, Betts J, Bingmann T, Yung AR, Berk M, McGorry PD. The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study. Bipolar Disord 2014; 16:493-504. [PMID: 24797824 DOI: 10.1111/bdi.12205] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. METHODS This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania. RESULTS A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder. CONCLUSIONS These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.
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Affiliation(s)
- Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban, Academic Hospital of Charite Medicine Berlin, Berlin, Germany; Orygen Youth Health Research Centre; Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Pfennig A, Leopold K, Bechdolf A, Correll CU, Holtmann M, Lambert M, Marx C, Meyer TD, Pfeiffer S, Reif A, Rottmann-Wolf M, Schmitt NM, Stamm T, Juckel G, Bauer M. Early specific cognitive-behavioural psychotherapy in subjects at high risk for bipolar disorders: study protocol for a randomised controlled trial. Trials 2014; 15:161. [PMID: 24886581 PMCID: PMC4020379 DOI: 10.1186/1745-6215-15-161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/08/2014] [Indexed: 11/25/2022] Open
Abstract
Background Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in- and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo)affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised. Trial registration WHO International Clinical Trials Platform (ICTRP), identifier: DRKS00000444, date of registration: 16 June 2010.
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Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
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Post RM, Altshuler L, Kupka R, McElroy S, Frye MA, Rowe M, Leverich GS, Grunze H, Suppes T, Keck PE, Nolen WA. More pernicious course of bipolar disorder in the United States than in many European countries: implications for policy and treatment. J Affect Disord 2014; 160:27-33. [PMID: 24709019 DOI: 10.1016/j.jad.2014.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is some controversy but growing evidence that childhood onset bipolar disorder may be more prevalent and run a more difficult course in the United States than some European countries. METHODS We update and synthesize course of illness data from more than 960 outpatients with bipolar disorder (average age 40) from 4 sites in the U.S. and 3 sites in Netherlands and Germany. After giving informed consent, patients reported on parental history, childhood and lifetime stressors, comorbidities, and illness characteristics. RESULTS Almost all aspects of bipolar disorder were more adverse in patients from the US compared with Europe, including a significantly higher prevalence of: bipolar disorder in one parent and a mood disorder in both parents; childhood verbal, physical, or sexual abuse; stressors in the year prior to illness onset and the last episode; childhood onsets of bipolar illness; delay to first treatment; anxiety disorder, substance abuse, and medical comorbidity; mood episodes and rapid cycling; and nonresponse to prospective naturalistic treatment. LIMITATIONS Selection bias in the recruit of patients cannot be ruled out, but convergent data in the literature suggest that this does not account for the findings. Potential mechanisms for the early onset and more adverse course in the U.S. have not been adequately delineated and require further investigation. CONCLUSIONS The data suggest the need for earlier and more effective long-term treatment intervention in an attempt to ameliorate this adverse course and its associated heavy burden of psychiatric and medical morbidity.
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Affiliation(s)
- R M Post
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814, United States; Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., United States.
| | - L Altshuler
- UCLA Mood Disorders Research Program, VA Medical Center, Los Angeles, CA, United States
| | - R Kupka
- Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands
| | - S McElroy
- Lindner Center of HOPE Mason, OH, United States; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - M A Frye
- Psychiatry, Mayo Clinic, Rochester, MI, United States
| | - M Rowe
- Biostatistician, Bipolar Collaborative Network, Bethesda, MD, United States
| | - G S Leverich
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814, United States
| | - H Grunze
- Institute of Neuroscience, University of Newcastle upon Tyne, Newcastle, United Kingdom
| | - T Suppes
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - P E Keck
- Psychiatry & Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Lindner Center of HOPE Mason, OH, United States
| | - W A Nolen
- University Medical Center, University of Groningen, Groningen, Netherlands
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Lecardeur L, Benarous X, Milhiet V, Consoli A, Cohen D. [Management of bipolar 1 disorder in children and adolescents]. Encephale 2014; 40:143-53. [PMID: 24656684 DOI: 10.1016/j.encep.2014.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/17/2014] [Indexed: 11/15/2022]
Abstract
Lifetime prevalence of child and adolescent bipolar 1 disorder (BD1) is nearly 0.1 %. Even though it is not a frequent disorder in young people, there is an increased interest for this disorder at this age, because of the poor outcome, the severe functional impairments and the major risk of suicide. Diagnosis is complex in view of the more frequent comorbidities, the variability with an age-dependant clinical presentation, and the overlap in symptom presentation with other psychiatric disorders (e.g. disruptive disorders in prepubertal the child and schizophrenia in the adolescent). The presentation in adolescents is very similar to that in adults and in prepubertal children chronic persistent irritability and rapid mood oscillation are often at the foreground. For a while, such presentations were considered as BD-not otherwise specified (BD-NOS), which can explain the outburst of the prevalence of bipolar disorder in children in the US. Longitudinal studies that look for the outcome of such emotional dysregulations have not revealed an affiliation with bipolar disorder spectrum, but with depressive disorders in adulthood. The diagnosis of Disruptive Mood Dysregulation Disorder was proposed in the DSM-5 to identify these children and to prevent confusion with bipolar disorder. The goals of the pharmacological and psychosocial treatments are to control or ameliorate the symptoms, to avoid new episodes or recurrences, to improve psychosocial functioning and well-being, and to prevent suicide. In the US, lithium and four atypical antipsychotics have been approved by the FDA for 10 to 13-year-olds (risperidone, olanzapine, aripiprazole and quetiapine). In France, only lithium salts (after the age of 16) and aripiprazole (after the age of 13) are recommended. Psychosocial treatments, such as a familial or individual approach are developing.
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Affiliation(s)
- L Lecardeur
- Équipe mobile de soins intensifs, centre Esquirol, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France; CNRS, UMR 6301 ISTCT, ISTS group, GIP CYCERON, 14074 Caen, France; CEA, DSV/I2BM, UMR 6301 ISTCT, 14074 Caen, France; Université de Caen Basse-Normandie, UMR 6301 ISTCT, 14074 Caen, France.
| | - X Benarous
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - V Milhiet
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - A Consoli
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France
| | - D Cohen
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France; CNRS UMR 7222, institut des systèmes intelligents et robotiques, université Pierre-et-Marie-Curie, 75252 Paris cedex 05, France
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Maoz H, Goldstein T, Axelson DA, Goldstein BI, Fan J, Hickey MB, Monk K, Sakolsky D, Diler RS, Brent D, Iyengar S, Kupfer DJ, Birmaher B. Dimensional psychopathology in preschool offspring of parents with bipolar disorder. J Child Psychol Psychiatry 2014; 55:144-53. [PMID: 24372351 PMCID: PMC4017915 DOI: 10.1111/jcpp.12137] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study is to compare the dimensional psychopathology, as ascertained by parental report, in preschool offspring of parents with bipolar disorder (BP) and offspring of community control parents. METHODS 122 preschool offspring (mean age 3.3 years) of 84 parents with BP, with 102 offspring of 65 control parents (36 healthy, 29 with non-BP psychopathology), were evaluated using the Child Behavior Checklist (CBCL), the CBCL-Dysregulation Profile (CBCL-DP), the Early Childhood Inventory (ECI-4), and the Emotionality Activity Sociability (EAS) survey. Teachers' Report Forms (TRF) were available for 51 preschoolers. RESULTS After adjusting for confounders, offspring of parents with BP showed higher scores in the CBCL total, externalizing, somatic, sleep, aggressive, and CBCL-DP subscales; the ECI-4 sleep problem scale; and the EAS total and emotionality scale. The proportion of offspring with CBCL T-scores ≥ 2 SD above the norm was significantly higher on most CBCL subscales and the CBCL-DP in offspring of parents with BP compared to offspring of controls even after excluding offspring with attention deficit hyperactivity disorder and/or oppositional defiant disorder. Compared to offspring of parents with BP-I, offspring of parents with BP-II showed significantly higher scores in total and most CBCL subscales, the ECI-4 anxiety and sleep scales and the EAS emotionality scale. For both groups of parents, there were significant correlations between CBCL and TRF scores (r = .32-.38, p-values ≤.02). CONCLUSIONS Independent of categorical axis-I psychopathology and other demographic or clinical factors in both biological parents, preschool offspring of parents with BP have significantly greater aggression, mood dysregulation, sleep disturbances, and somatic complaints compared to offspring of control parents. Interventions to target these symptoms are warranted.
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Affiliation(s)
- Hagai Maoz
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David A. Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Benjamin I. Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jieyu Fan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Hickey
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelly Monk
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dara Sakolsky
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rasim S. Diler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Brent
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Satish Iyengar
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J. Kupfer
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Pfennig A, Correll CU, Marx C, Rottmann-Wolf M, Meyer TD, Bauer M, Leopold K. Psychotherapeutic interventions in individuals at risk of developing bipolar disorder: a systematic review. Early Interv Psychiatry 2014; 8:3-11. [PMID: 23968367 DOI: 10.1111/eip.12082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/15/2013] [Indexed: 12/21/2022]
Abstract
AIM Accumulating data show that patients with bipolar disorder (BD) experience substantial symptomatology months or years before full manifestation. Based on the need for early preventive interventions in BD as well as data suggesting effectiveness of psychotherapeutic interventions for BD, we aimed to review the evidence for psychotherapeutic treatments in help-seeking individuals considered at risk for BD (At-Risk-BD). METHODS Searching PubMed and PsycINFO, clinical trial registries and recently published systematic reviews, a systematic review was performed of psychoeducational and psychotherapeutic intervention studies in At-Risk-BD individuals. RESULTS Only three completed studies were identified, two of which were randomized trials (n = 77) and one was an open pilot study (n = 13). Two ongoing studies (projected n = 150 and n = 100, respectively) were found in trial registries. The available evidence suggests potential effectiveness of multi-family psychoeducational psychotherapy and family-focussed therapy for symptom reduction and prevention of BD conversion. CONCLUSIONS Psychotherapeutic treatments are a reasonable starting point for At-Risk-BD subjects when symptom severity, distress and impairment are sufficiently significant to initiate treatment. Ongoing studies will further clarify the effectiveness and timing of psychotherapeutic interventions for At-Risk-BD individuals and whether or not they should be given alone or in conjunction with other treatments. Large multi-site studies with standardized procedures/manuals are needed to advance the field.
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Affiliation(s)
- Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische University Dresden, Dresden, Germany
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Noto MN, de Souza Noto C, de Jesus DR, Zugman A, Mansur RB, Berberian AA, Leclerc E, McIntyre RS, Correll CU, Brietzke E. Recognition of bipolar disorder type I before the first manic episode: challenges and developments. Expert Rev Neurother 2014; 13:795-806; quiz 807. [DOI: 10.1586/14737175.2013.811132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Leopold K, Ratzer S, Correll CU, Rottmann-Wolf M, Pfeiffer S, Ritter P, Bauer M, Pfennig A. Characteristics, symptomatology and naturalistic treatment in individuals at-risk for bipolar disorders: baseline results in the first 180 help-seeking individuals assessed at the Dresden high-risk project. J Affect Disord 2014; 152-154:427-33. [PMID: 24206928 DOI: 10.1016/j.jad.2013.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/04/2013] [Accepted: 10/04/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Considering results from the early recognition and intervention in psychosis, identification and treatment of individuals with at-risk states for the development of bipolar disorders (BD) could improve the course and severity of illness and prevent long-term consequences. Different approaches to define risk factors and groups have recently been published, data on treatment options are still missing. METHODS Help-seeking persons at the early recognition center in Dresden, Germany, were assessed with a standardized diagnostic procedure including following risk factors for BD: familial risk, increasing mood swings, subsyndromal (hypo)manic symptoms, specific sleep and circadian rhythm disturbances, anxiety/fearfulness, affective disorder, decreased psychosocial functioning, increasing periodic substance use, and attention-deficit/hyperactivity disorder. Based on symptomatology and current and/or life-time psychiatric diagnosis, subjects with an at-risk state were offered individual treatment options. RESULTS Out of 180 referred and screened persons, 29 (16%) met criteria for at-risk state for BD. Altogether, 27 (93%) at-risk individuals fulfilled criteria for a current and/or life-time mental illness other than BD; 14 (48%) had received pharmacological and/or psychotherapeutic treatment in the past. Treatments recommended included psychoeducation (100%), psychotherapy alone (62%), pharmacotherapy alone (17%), and psychotherapy+pharmacotherapy (14%). CONCLUSIONS To identify at-risk states for BD, a multifactorial approach including all known risk markers should be used. As most at-risk patients meet criteria for other mental disorders, the short- and long-term impact of different treatment strategies on symptomatic, functional and diagnostic outcomes requires detailed investigation. LIMITATIONS Small sample size of at-risk individuals, lack of sufficient prospective data and control groups.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany.
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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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Post RM, Altshuler L, Leverich G, Nolen W, Kupka R, Grunze H, Frye M, Suppes T, McElroy S, Keck P, Rowe M. More stressors prior to and during the course of bipolar illness in patients from the United States compared with the Netherlands and Germany. Psychiatry Res 2013; 210:880-6. [PMID: 24021999 DOI: 10.1016/j.psychres.2013.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 08/02/2013] [Accepted: 08/08/2013] [Indexed: 02/08/2023]
Abstract
Considerable data suggest that compared to some European countries, in the U.S. there are more childhood onset bipolar disorders, more adverse courses of illness, and greater treatment resistance. Psychosocial variables related to these findings have not been adequately explored. Therefore we analyzed psychosocial stressors in three time domains: childhood; the year prior to illness Onset; and the Last Episode from questionnaires in 968 outpatients (mean age 41) with bipolar I or II disorder; 676 from four sites in the U.S. and 292 from three in the Netherlands and Germany (abbreviated here as Europe). Compared to the Europeans, those from the U.S. had significantly more stressors in childhood and prior to the last episode. Stressors prior to the last episode were related to: childhood stressors; an earlier age at illness onset; anxiety and substance abuse comorbidity; lower income; both parents having an affective illness; and feeling more stigma. These data suggest a greater prevalence of adverse life events in childhood and over the course of bipolar illness in the U.S. compared to the Netherlands and Germany. Clinical, therapeutic, and public health approaches to these illness-relevant stressors require further exploration.
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Affiliation(s)
- Robert M Post
- Bipolar Collaborative Network, Bethesda MD; Clinical Professor Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C.; Bipolar Collaborative Network, Bethesda, MD, USA.
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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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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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Whitney J, Howe M, Shoemaker V, Li S, Sanders EM, Dijamco C, Acquaye T, Phillips J, Singh M, Kiki Chang M. Socio-emotional processing and functioning of youth at high risk for bipolar disorder. J Affect Disord 2013; 148:112-7. [PMID: 23123133 PMCID: PMC3644339 DOI: 10.1016/j.jad.2012.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 08/16/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this study was to investigate differences in socio-emotional processing and functioning in children and adolescents at high risk for bipolar disorder (BD) and healthy control participants. METHODS Children and adolescents with a parent with bipolar disorder, who had mood dysregulation but not fully syndromal BD (high risk, HR, n=24), were compared to participants with no personal or family history of psychopathology (healthy control, HC, n=27) across several neuropsychological domains. Social reciprocity was measured by the Social Responsiveness Scale, theory of mind was measured by use of the NEPSY, and affect recognition was measured by the NEPSY and the Diagnostic Test of Nonverbal Accuracy 2 (DANVA). RESULTS The HR group demonstrated significant impairment in social reciprocity, including impairments in social awareness, social cognition, social communication, social motivation, and autistic mannerisms. There were no significant group differences in performance on theory of mind or affect recognition tasks. LIMITATIONS Lack of impairment in tasks associated with theory of mind or affect recognition indicate that social functioning difficulties are not likely due to impairments in these areas, or that the measures employed were not sufficiently sensitive to detect group differences. CONCLUSIONS Youth at high risk for BD demonstrated impairments in numerous social domains, which may be due to innate differences in brain development governing socio-emotional functioning or may be due to disruptions in normal development caused by mood regulation difficulties.
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Affiliation(s)
- Jane Whitney
- Pediatric Bipolar Disorders Program, Stanford University, Stanford, CA 94305-5540, United States.
| | - Meghan Howe
- Pediatric Bipolar Disorders Program,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Virginia Shoemaker
- Pediatric Bipolar Disorders Program,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Sherrie Li
- Pediatric Bipolar Disorders Program,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Erica Marie Sanders
- Pediatric Bipolar Disorders Program,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Cheri Dijamco
- Pediatric Bipolar Disorders Program,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Tenah Acquaye
- Pediatric Bipolar Disorders Program,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Jennifer Phillips
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Manpreet Singh
- Pediatric Bipolar Disorders Program,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - M.S. Kiki Chang
- Pediatric Bipolar Disorders Program,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
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Demeter CA, Youngstrom EA, Carlson GA, Frazier TW, Rowles BM, Lingler J, McNamara NK, Difrancesco KE, Calabrese JR, Findling RL. Age differences in the phenomenology of pediatric bipolar disorder. J Affect Disord 2013; 147:295-303. [PMID: 23219057 DOI: 10.1016/j.jad.2012.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The primary purpose of this study was to explore whether age differences in the phenomenology of bipolar disorders from 4 to 17 years of age exist. METHODS Outcome measures included questionnaires pertaining to mood symptoms, psychosocial functioning, and family history of psychiatric illness. Phenomenology was examined in two diagnostic groups: syndromal bipolar disorder (bipolar I or II) and subsyndromal bipolar disorder (bipolar disorder not otherwise specified or cyclothymia) and across six age cohorts: 4-6, 7-8, 9-10, 11-13, and 14-17 years. Analyses examined linear and non-linear age effects on clinician-rated measures of mood and psychosocial functioning. RESULTS Participants were 535 outpatients (339 males) ages 4-17 years. The proportion diagnosed with comorbid ADHD was significantly lower in the oldest age group. Age groups showed significant moderate decreases in motor activity, aggression, and irritability with age. Many symptoms of depression showed significant increases with age. BP I cases showed much higher manic symptoms, and BP I and BP II cases indicated slightly to moderately higher depressive symptoms, compared to subsyndromal cases. These patterns held after adjusting for comorbid ADHD, and age did not interact with syndrome status. There were also age differences in total scores for measures of mood symptoms and psychosocial functioning. LIMITATIONS Mood ratings were completed based on the same interview that informed the research diagnoses. Also, mood episode at time of interview was not captured. CONCLUSIONS These findings affirm the existence of bipolar disorder from pre-school children through adolescence, with a similar clinical presentation across a wide developmental age span.
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Affiliation(s)
- Christine A Demeter
- Department of Psychiatry, Case Western Reserve University, University Hospitals of Cleveland, OH, United States.
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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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