title: A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder.
abstract: BACKGROUND
  Bipolar patients are at risk for relapses of their illness even when undergoing optimal pharmacotherapy. This study was performed to determine whether combining family-focused therapy (FFT) with pharmacotherapy during a postepisode interval enhances patients' mood stability during maintenance treatment.
  
  
  METHODS
  In a randomized controlled trial, 101 bipolar patients were assigned to FFT and pharmacotherapy or a less intensive crisis management (CM) intervention and pharmacotherapy. Outcome assessments were conducted every 3 to 6 months for 2 years. Participants (mean +/- SD age, 35.6 +/- 10.2 years) were referred from inpatient or outpatient clinics after onset of a manic, mixed, or depressed episode. FFT consisted of 21 sessions of psychoeducation, communication training, and problem-solving skills training. Crisis management consisted of 2 sessions of family education plus crisis intervention sessions as needed. Both protocols lasted 9 months. Patients received pharmacotherapy for 2 study years. Main outcome measures included time to relapse, depressive and manic symptoms, and medication adherence.
  
  
  RESULTS
  Rates of study completion did not differ across the FFT (22/31, 71%) and CM groups (43/70, 61%). Patients undergoing FFT had fewer relapses (11/31, 35%) and longer survival intervals (mean +/- SD, 73.5 +/- 28.8 weeks) than patients undergoing CM (38/70, 54%; mean +/- SD, 53.2 +/- 39.6 weeks; hazard ratio, 0.38; 95% confidence interval, 0.20-0.75; P =.003; intent to treat). Patients undergoing FFT showed greater reductions in mood disorder symptoms and better medication adherence during the 2 years than patients undergoing CM.
  
  
  CONCLUSIONS
  Combining family psychoeducation with pharmacotherapy enhances the postepisode symptomatic adjustment and drug adherence of bipolar patients.
authors.affiliation: Department of Psychology, University of Colorado, Boulder, USA. miklow@email.unc.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: George
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Richards
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Simoneau
authors.forename: Richard L
authors.initials: RL
authors.lastname: Suddath
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000927:Anticonvulsants / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D003419:Crisis Intervention / Q000379:methods; D005192:Family Health; D005196:Family Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D011619:Psychotropic Drugs