Family-Focused Treatment for Adolescents with Bipolar Disorder: When Is It Worth the Effort?

Joel Yager, MD

Twenty-one sessions of adjunctive family-based treatment offered few benefits over three weekly psychoeducation sessions.

Several types of psychosocial interventions, including interpersonal and social rhythm therapy, have been shown to add benefit to medication management for adults with bipolar disorder. In a well-designed, well-conducted, 2-year, multisite study, 145 community-recruited adolescents diagnosed with bipolar I or II disorder (mean age, 15.6) were stratified by diagnostic group and polarity of initial episode and then randomized to protocol-driven medication management plus either 21 weekly sessions of family-focused therapy (FFT) over 9 months or three weekly psychoeducation sessions in the first month designed to mimic “enhanced” treatment as usual. FFT involved three modules on psychoeducation, communications-enhancement training, and problem-solving skills. Booster sessions were available to all participants. Adherence to medication protocols was assessed as full in 57% to 70% at the three sites and as partial in 17% to 27%.

Contrary to expectations, FFT yielded no additional benefits compared with enhanced care on several primary outcomes, including time to recovery, mood symptom severity, or number of weeks ill. However, in secondary analyses, patients receiving FFT showed fewer manic symptoms during year 2 of the study. Patients with comorbid anxiety disorders or not living with two biological parents had earlier mood recurrences.

Citation(s):

Miklowitz DJ et al. Pharmacotherapy and family-focused treatment for adolescents with bipolar I and II disorders: A 2-year randomized trial. Am J Psychiatry 2014 Mar 14; [e-pub ahead of print].