Early-onset bipolar disorder: a family treatment perspective.

Department of Psychology, University of Colorado, Boulder, CO 80309-0345, USA.
Development and Psychopathology (Impact Factor: 4.4). 02/2006; 18(4):1247-65. DOI: 10.1017/S0954579406060603
Source: PubMed

ABSTRACT Mood disorder symptoms and their associated functional impairments are hypothesized to come about as the result of the conjoint, interactive influences of genetic, biological, and psychological vulnerabilities, family distress, and life stress at different points of development. We discuss a developmental psychopathology model that delineates pathways to high family conflict and mood exacerbation among early-onset bipolar patients. New data from a treatment development study indicate that adolescent bipolar patients in high expressed emotion families have more symptomatic courses of illness over 2 years than adolescents in low expressed emotion families. Chronic and episodic stressors are also correlated with lack of mood improvement while adolescents are in treatment. Family-focused treatment (FFT) given in conjunction with pharmacotherapy appears to ameliorate the course of bipolar disorder in adults. This treatment has recently been modified to address the developmental presentation of bipolar disorder among adolescents. We present data from an open trial of FFT and pharmacotherapy (N = 20) indicating that bipolar adolescents stabilize in mania, depression, and parent-rated problem behaviors over 2 years. Future research should focus on clarifying the developmental pathways to early-onset bipolar disorder and the role of protective factors and preventative psychosocial interventions in delaying the first onset of the disorder.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In the last decades, psychotherapy has gained increasing acceptance as a major treatment option for mood disorders. Empirically supported treatments for major depression include cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), behavioural therapy and, to a lesser extent, short-term psychodynamic psychotherapy. Meta-analytic evidence suggests that psychotherapy has a significant and clinically relevant, though not large, effect on chronic forms of depression. Psychotherapy with chronic patients should take into account several important differences between patients with chronic and acute depression (identification with their depressive illness, more severe social skill deficits, persistent sense of hopelessness, need of more time to adapt to better circumstances). Regarding adolescent depression, the effectiveness of IPT and CBT is empirically supported. Adolescents require appropriate modifications of treatment (developmental approach to psychotherapy, involvement of parents in therapy). The combination of psychotherapy and medication has recently attracted substantial interest; the available evidence suggests that combined treatment has small but significant advantages over each treatment modality alone, and may have a protective effect against depression relapse or recurrence. Psychobiological models overcoming a rigid brain-mind dichotomy may help the clinician give patients a clear rationale for the combination of psychological and pharmacological treatment. In recent years, evidence has accumulated regarding the effectiveness of psychological therapies (CBT, family-focused therapy, interpersonal and social rhythm therapy, psychoeducation) as an adjunct to medication in bipolar disorder. These therapies share several common elements and there is considerable overlap in their actual targets. Psychological interventions were found to be useful not only in the treatment of bipolar depressive episodes, but in all phases of the disorder.
    Clinical Practice and Epidemiology in Mental Health 11/2014; 10:140-158.
  • [Show abstract] [Hide abstract]
    ABSTRACT: [Clin Psychol Sci Prac 18: 342–356, 2011] This article reviews studies of interpersonal functioning, social cognition, and life stress in children and adolescents with bipolar disorder (BD). Peer and family relationships of youth with BD are impaired in comparison to healthy controls and youth with attention‐deficit hyperactivity disorder (ADHD). Social‐cognitive deficits, such as impaired facial affect recognition, may underlie these interpersonal difficulties. Affect among youth with BD is particularly dysregulated in interpersonal situations and is often characterized by elevated anger and frustration. Preliminary evidence suggests that life stress is associated with course. Further research in this area must consider the role of comorbidity and family environment in determining psychosocial outcomes. Studies should aim to incorporate naturalistic and developmentally appropriate measures of social functioning and examine the impact of psychosocial interventions in modifying social dysfunction.
    Clinical Psychology Science and Practice 12/2011; 18(4). · 2.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite efforts that have been made to develop and evaluate psychosocial interventions for youth with bipolar spectrum disorders (BPSDs), there has been limited evidence regarding treatment delivery and consumer experiences in clinical settings. Two parallel web-based surveys were conducted to assess clinicians' experiences with providing psychosocial treatments to youth with BPSD, and caregivers' experiences with accessing and receiving care for their youth with BSPD. Clinicians who were members of the American Psychological Association's Division 53 listserv were invited to report on (1) their training in and knowledge of BPSD among youth; (2) types of treatments they had provided and their perceived effectiveness; (3) treatment-related challenges; and (4) further training opportunities or resources they desire. Caregivers who were members of the Balanced Mind Foundation listserv were invited to participate in a separate survey. They were asked to report on both negative and positive experiences they had in their most recent experience with accessing and receiving psychosocial treatment for their youth with BPSD. Overall, the majority of clinician respondents reported receiving training in providing psychosocial treatments to youth with BPSD, though most reported desiring further training and greater access to resources (e.g., treatment manuals, workshops, case consultation). Caregivers indicated overall positive experiences with psychosocial treatments for their youth with BPSD. Positive experiences included those associated with nonspecific factors of therapy, and negative experiences included content-related factors and barriers to accessing treatments. Implications for enhancing treatment delivery and overall experience of psychosocial interventions among youth with BPSD are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Professional Psychology Research and Practice 01/2012; 43(6):633. · 1.34 Impact Factor