Integrated family and individual therapy for bipolar disorder: results of a treatment development study.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Miklowitz
David J
DJ
Department of Psychology, University of Colorado, Boulder 80309, USA. miklow@psych.colorado.edu
Richards
Jeffrey A
JA
George
Elizabeth L
EL
Frank
Ellen
E
Suddath
Richard L
RL
Powell
Kristin B
KB
Sacher
Jennifer A
JA
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D003419:Crisis Intervention / Q000379:methods; D005196:Family Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D011615:Psychotherapy, Group / Q000379:methods; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D008094:Lithium