title: Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial.
abstract: BACKGROUND
  Family interventions have been found to hasten episode recovery and delay recurrences among adults with bipolar disorder.
  
  
  OBJECTIVE
  To examine the benefits of family-focused treatment for adolescents (FFT-A) and pharmacotherapy in the 2-year course of adolescent bipolar disorder.
  
  
  METHODS
  Two-site outpatient randomized controlled trial with 2-year follow-up.
  
  
  METHODS
  A referred sample of 58 adolescents (mean [SD] age, 14.5 [1.6] years) with bipolar I (n = 38), II (n = 6), or not otherwise specified disorder (n = 14) with a mood episode in the prior 3 months.
  
  
  METHODS
  Patients were randomly assigned to FFT-A and protocol pharmacotherapy (n = 30) or enhanced care (EC) and protocol pharmacotherapy (n = 28). The FFT-A consisted of 21 sessions in 9 months of psychoeducation, communication training, and problem-solving skills training. The EC consisted of 3 family sessions focused on relapse prevention.
  
  
  METHODS
  Independent "blind" evaluators assessed patients every 3 to 6 months for 2 years. Outcomes included time to recovery from the index episode, time to recurrence, weeks in episode or remission, and mood symptom severity scores.
  
  
  RESULTS
  Analyses were by intent to treat. Rates of 2-year study completion did not differ across the FFT-A (60.0%) and EC conditions (64.3%). Although there were no group differences in rates of recovery from the index episode, patients in FFT-A recovered from their baseline depressive symptoms faster than patients in EC (hazard ratio, 1.85; 95% confidence interval, 1.04-3.29; P = .04). The groups did not differ in time to recurrence of depression or mania, but patients in FFT-A spent fewer weeks in depressive episodes and had a more favorable trajectory of depression symptoms for 2 years.
  
  
  CONCLUSIONS
  Family-focused therapy is effective in combination with pharmacotherapy in stabilizing bipolar depressive symptoms among adolescents. To establish full recovery, FFT-A may need to be supplemented with systematic care interventions effective for mania symptoms.
authors.affiliation: Department of Psychology, University of Colorado, Boulder, CO 80309-0345, USA. miklowitz@colorado.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: David A
authors.initials: DA
authors.lastname: Axelson
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: George
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Schneck
authors.forename: Carol A
authors.initials: CA
authors.lastname: Beresford
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: W Edward
authors.initials: WE
authors.lastname: Craighead
authors.forename: David A
authors.initials: DA
authors.lastname: Brent