Interpersonal and social rhythm therapy for adolescents with bipolar disorder: Treatment development and results from an open trial

ArticleinDepression and Anxiety 27(5):457-64 · May 2010with36 Reads
Impact Factor: 4.41 · DOI: 10.1002/da.20668 · Source: PubMed
Abstract

In adolescents and adults, bipolar disorder (BD) is associated with significant morbidity, mortality, and impairment in psychosocial and occupational functioning. IPSRT is an empirically supported adjunctive psychotherapy for adults with bipolar disorder, which has been shown to help delay relapse, speed recovery from a bipolar depressive episode, and increase occupational and psychosocial functioning in adults with BD. This study is designed to describe the adolescent-specific developmental adaptations made to IPSRT (i.e., IPSRT-A) and to report the results from an open trial of IPSRT-A with 12 adolescents with a bipolar spectrum disorder. Interpersonal and Social Rhythm Therapy was adapted to be developmentally relevant to adolescents with bipolar disorder. Twelve adolescents (mean age 16.5+/-1.3 years) diagnosed with a bipolar spectrum disorder participated in 16-18 sessions of adjunctive IPSRT-A over 20 weeks. Manic, depressive, and general symptoms and global functioning were measured at baseline, monthly during treatment, and at post-treatment. Adolescent satisfaction with treatment was also measured. Feasibility and acceptability of IPSRT-A were high; 11/12 participants completed treatment, 97% of sessions were attended, and adolescent-rated satisfaction scores were high. IPSRT-A participants experienced significant decreases in manic, depressive, and general psychiatric symptoms over the 20 weeks of treatment. Participants' global functioning increased significantly as well. Effect sizes ranged from medium-large to large. IPSRT-A appears to be a promising adjunctive treatment for adolescents with bipolar disorder. A current randomized controlled trial is underway to examine effects of adjunctive IPSRT-A on psychiatric symptoms and psychosocial functioning.

    • "... to maintain a stable lifestyle (Bouwkamp et al., 2013; Frank et al., 2008; Harvey, 2011; Hlastala et al., 2010; Sachs, 2008). Hence, beyond pharmacological challenges, changes in the environment of the sufferer ..."
      Hence, BD sufferers may have a susceptibility to SRD that underlies shifting moods. Although the mechanism(s) underlying this theory have yet to be determined, it has resulted in efficacious treatment development called social rhythm therapy (SRT) designed to maintain a stable lifestyle (Bouwkamp et al., 2013; Frank et al., 2008; Harvey, 2011; Hlastala et al., 2010; Sachs, 2008). Hence, beyond pharmacological challenges, changes in the environment of the sufferer can induce switches in mood.induced
    [Show abstract] [Hide abstract] ABSTRACT: Bipolar Disorder (BD) is a unique disorder that transcends domains of function since the same patient can exhibit depression or mania, states with polar opposite mood symptoms. During depression, people feel helplessness, reduced energy, and risk aversion, while with mania behaviors include grandiosity, increased energy, less sleep, and risk preference. The neural mechanism(s) underlying each state are gaining clarity, with catecholaminergic disruption seen during mania, and cholinergic dysfunction during depression. The fact that the same patient cycles/switches between these states is the defining characteristic of BD however. Of greater importance therefore, is the mechanism(s) underlying cycling from one state - and its associated neural changes - to another, considered the 'holy grail' of BD research. Herein, we review studies investigating triggers that induce switching to these states. By identifying such triggers, researchers can study neural mechanisms underlying each state and importantly how such mechanistic changes can occur in the same subject. Current animal models of this switch are also discussed, from submissive- and dominant-behaviors to kindling effects. Focus however, is placed on how seasonal changes can induce manic and depressive states in BD sufferers. Importantly, changing photoperiod lengths can induce local switches in neurotransmitter expression in normal animals, from increased catecholaminergic expression during periods of high activity, to increased somatostatin and corticotrophin releasing factor during periods of low activity. Identifying susceptibilities to this switch would enable the development of targeted animal models. From animal models, targeted treatments could be developed and tested that would minimize the likelihood of switching. Copyright © 2015. Published by Elsevier B.V.
    Full-text · Article · Mar 2015 · European journal of pharmacology
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    • "...alık terapi sonunda manik, depresif ve genel psikiyatrik belirtilerde anlamlı düzelme izlenmiştir.[37] Birinci derece akrabalarında bipolar bozukluk tanısı olan ergenlerde yapılan bir başka çalışmada is..."
      Bipolar bozuklukta grup terapisinde yapılan KİSRT uygulamasında bir yıllık süreçte depresif belirtilerde ve hastaneye yatış oranlarında azalma olduğu bildirilmiştir.[36] Bipolar bozukluk tanısı olan 12 ergende KİSRT uygulanan bir açık çalışmada ise hastaların seanslara düzenli katılma oranı %97 olarak bulunmuş, 20 haftalık terapi sonunda manik, depresif ve genel psikiyatrik belirtilerde anlamlı düzelme izlenmiştir.[37] Birinci derece akrabalarında bipolar bozukluk tanısı olan ergenlerde yapılan bir başka çalışmada ise 6 ay boyunca 12 seans KİSRT uygulanan gençler terapinin bitiminden sonra altı ay süreyle takip edilmişler ve KİSRT ile uyku düzeni ve sirkadyen ritimde anlamlı düzelme olduğu, günlük ritmin stabilizasyonunun riskli ergenler için faydalı olduğu saptanmış- tır.[38]
    Full-text · Article · Apr 2014
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    • "...ania, and functioning as well as a medium-to-large improvement in depression (Hlastala, Kotler, McClellan, & McCauley, 2010). IPSRT appears to be a promising treatment for adolescent bipolar spectrum disorders. ..."
      Parents and other family members participated in two to three psychoeducational sessions to bolster treatment gains at home. An open trial found the intervention feasible (97% attendance rate) and efficacious, demonstrating large improvements in general psychiatric symptomatology, mania, and functioning as well as a medium-to-large improvement in depression (Hlastala, Kotler, McClellan, & McCauley, 2010). IPSRT appears to be a promising treatment for adolescent bipolar spectrum disorders.
    [Show abstract] [Hide abstract] ABSTRACT: We employed standard literature search techniques and surveyed participants on the International Society for Interpersonal Psychotherapy listserve (isiptlist@googlegroups.com) to catalogue the multiple and highly creative ways in which Klerman's and Weissman's original concept of interpersonal psychotherapy (IPT) has been modified to meet the needs of a vast range of patient populations. Focusing first on adaptations of the individual treatment model for subgroups of adult patients, we next describe further adaptations of four major off-shoots of IPT: interpersonal counseling (IPC), IPT for adolescents (IPT-A), group IPT (IPT-G) and most recently, brief IPT (IPT-B). We then discuss IPT “in-laws,” those treatments that have married IPT with of other forms of psychotherapy for patients with bipolar disorder, panic symptomatology, and substance abuse. We conclude with that although there have been myriad successful adaptations of IPT, there remain some conditions for which IPT adaptations have not been found to be efficacious.
    No preview · Article · Jan 2014 · American journal of psychotherapy
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