Integrated Family and Individual Therapy for Bipolar Disorder

Department of Psychology, University of Colorado, Boulder 80309, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 03/2003; 64(2):182-91. DOI: 10.4088/JCP.v64n0211
Source: PubMed


Several studies have established the efficacy of psychosocial interventions as adjuncts to pharmacotherapy in the symptom maintenance of bipolar disorder. This study concerned a new psychosocial approach - integrated family and individual therapy (IFIT) - that synthesizes family psychoeducational sessions with individual sessions of interpersonal and social rhythm therapy.
Shortly after an acute illness episode, 30 bipolar patients (DSM-IV criteria) were assigned to open treatment with IFIT (up to 50 weekly sessions of family and individual therapy) and mood-stabilizing medications in the context of a treatment development study. Their outcomes over 1 year were compared with the outcomes of 70 patients from a previous trial who received standard community care, consisting of 2 family educational sessions, mood-stabilizing medications, and crisis management (CM). Patients in both samples were evaluated as to symptomatic functioning at entry into the project and then every 3 months for 1 year.
Patients in IFIT had longer survival intervals (time without relapsing) than patients in CM. They also showed greater reductions in depressive symptoms over 1 year of treatment relative to their baseline levels. The results could not be explained by group differences in baseline symptoms or pharmacologic treatment regimens.
Combining family and individual therapy with medication may protect episodic bipolar patients from early relapse and ongoing depressive symptoms. Further examination of this integrative model within randomized controlled trials is warranted.

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    • "Al contrario, la TCC e la PE di gruppo possono apportare maggiori benefici se attuate dopo un adeguato periodo di eutimia. Un approccio psicosociale integrato (definito Integrated Family and Individual Therapy, IFIT) ha combinato elementi della FFT con elementi della IPSRT [44]; gli autori hanno sottoposto 30 pazienti bipolari di tipo I, subito dopo un episodio acuto, a un trattamento che prevedeva 25 sessioni di IPSRT e 25 sessioni di FFT. Il decorso a 12 mesi di tali pazienti รจ stato U. Albert et al. confrontato con quello di un gruppo costituito da 70 pazienti arruolati come controlli (crisis management group) in un altro studio [35]. "
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    ABSTRACT: IntroductionBipolar Disorder (BD) is a chronic illness that significantly impairs functioning and the quality of life of patients and their relatives. Pharmacological treatment with mood stabilizers, first-line treatment, is not always sufficient to completely relieve symptoms and restore functioning. In recent years, psychosocial interventions have been proposed as possible adjuncts to pharmacological treatments.
    Quaderni Italiani di Psychiatria 03/2011; 30(1):3-15. DOI:10.1016/j.quip.2011.01.001
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    • "The present study did not include direct measures of important constructs such as expressed emotion or parent-child attachment (e.g., Hammen et al. 1990). These more proximal family variables may also be explanatory factors in families with bipolar disorder for both adults (Hooley and Hiller 2001) as well as youths (Geller et al. 2003; Miklowitz et al. 2003b). Despite these limitations, these findings lay the groundwork for future testing of causal pathways linking parental bipolar disorder, family functioning and conflict, and children's bipolar disorder and hold important implications for clinicians treating families with bipolar disorder. "
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    ABSTRACT: Investigated the association between family functioning and conflict and their links with mood disorder in parents and with children's risk for bipolar disorder. Participants were 272 families with a child between the ages of 5-17 years. Parents' history of psychiatric diagnoses and children's current diagnoses were obtained via semi-structured interviews. Parent report on the Family Assessment Device and the Conflict Behavior Questionnaire measured family functioning and conflict, respectively. Results revealed a small but significant indirect pathway from parental diagnosis of mood disorder to child bipolar disorder through impaired family functioning, via increased family conflict. Parental mood disorders were also significantly related to other negative outcomes in children, including unipolar depression and oppositional defiant disorder. Associations between parent diagnoses and family functioning changed depending on youth age, but not youth sex.
    Journal of Abnormal Child Psychology 09/2008; 36(6):849-63. DOI:10.1007/s10802-008-9217-9 · 3.48 Impact Factor
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    • "A similar study by Rea and colleagues (Rea et al., 2003) found no benefit of FFT in reducing the risk of relapse; however, patients receiving FFT had fewer relapses than those receiving individually focused treatment. Other benefits of FFT included greater reductions in affective symptom scores (Miklowitz et al., 2003), better medication adherence (Miklowitz et al., 2003), and lower risk of rehospitalization over a 2-year period (Rea et al., 2003). The results of these studies provide evidence that FFT may be a useful adjunct to pharmacotherapy for decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder. "
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    ABSTRACT: Bipolar disorder is a chronic, severe condition commonly causing substantial mortality and psychosocial morbidity. Challenges in recognition can delay the institution of appropriate management, whereas misdiagnosis may initiate pharmacologic interventions that adversely affect the condition's course. Pharmacotherapy remains the foundation of treatment. In addition to efficacy, tolerability is an important consideration in medication choice, particularly for long-term maintenance because of its impact on adherence. Mood stabilizers are the classic treatments for bipolar disorder. Newer agents such as atypical antipsychotics may offer efficacy and/or tolerability advantages compared with other medications. The role of antidepressants in bipolar disorder remains controversial. Growing evidence indicates that adjunctive psychosocial interventions improve long-term functioning; consequently, psychologists are becoming increasingly involved in the long-term care of patients with bipolar disorder. This review seeks to update psychologists and related healthcare professionals on recent advances and the current limitations in the diagnosis and treatment of bipolar disorder.
    Journal of Clinical Psychology 01/2007; 63(1):73-92. DOI:10.1002/jclp.20333 · 2.12 Impact Factor
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