Expressed emotion moderates the effects of family-focused treatment for bipolar adolescents.
OBJECTIVE
Family interventions have been found to be effective in pediatric bipolar disorder (BD). This study examined the moderating effects of parental expressed emotion (EE) on the 2-year symptomatic outcomes of adolescent BD patients assigned to family-focused therapy for adolescents (FFT-A) or a brief psychoeducational treatment (enhanced care [EC]).


METHODS
A referred sample of 58 adolescents (mean age 14.5 +/- 1.6 years, range 13-17 years) with BD I, II, or not otherwise specified was randomly allocated after a mood episode to FFT-A or EC, both with protocol pharmacotherapy. Levels of EE (criticism, hostility, or emotional overinvolvement) in parents were assessed through structured interviews. Adolescents and parents in FFT-A underwent 21 sessions in 9 months of psychoeducation, communication training, and problem-solving skills training, whereas adolescents and parents in EC underwent 3 psychoeducation sessions. Independent "blind" evaluators assessed adolescents' depressive and manic symptoms every 3 to 6 months for 2 years.


RESULTS
Parents rated high in EE described their families as lower in cohesion and adaptability than parents rated low in EE. Adolescents in high-EE families showed greater reductions in depressive and manic symptoms in FFT-A than in EC. Differential effects of FFT-A were not found among adolescents in low-EE families. The results could not be attributed to differences in medication regimens.


CONCLUSIONS
Parental EE moderates the impact of family intervention on the symptomatic trajectory of adolescent BD. Assessing EE before family interventions may help determine which patients are most likely to benefit from treatment.
Miklowitz
David J
DJ
Drs. Miklowitz, George, Taylor and Ms. Sullivan are with the University of Colorado; Drs. Axelson and Birmaher are with the University of Pittsburgh School of Medicine; and Drs. Miklowitz, Schneck, and Dickinson are with the University of Colorado Denver Health Sciences Center. Electronic address: Miklowitz@colorado.edu.
Axelson
David A
DA
Drs. Miklowitz, George, Taylor and Ms. Sullivan are with the University of Colorado; Drs. Axelson and Birmaher are with the University of Pittsburgh School of Medicine; and Drs. Miklowitz, Schneck, and Dickinson are with the University of Colorado Denver Health Sciences Center.
George
Elizabeth L
EL
Drs. Miklowitz, George, Taylor and Ms. Sullivan are with the University of Colorado; Drs. Axelson and Birmaher are with the University of Pittsburgh School of Medicine; and Drs. Miklowitz, Schneck, and Dickinson are with the University of Colorado Denver Health Sciences Center.
Taylor
Dawn O
DO
Drs. Miklowitz, George, Taylor and Ms. Sullivan are with the University of Colorado; Drs. Axelson and Birmaher are with the University of Pittsburgh School of Medicine; and Drs. Miklowitz, Schneck, and Dickinson are with the University of Colorado Denver Health Sciences Center.
Schneck
Christopher D
CD
Drs. Miklowitz, George, Taylor and Ms. Sullivan are with the University of Colorado; Drs. Axelson and Birmaher are with the University of Pittsburgh School of Medicine; and Drs. Miklowitz, Schneck, and Dickinson are with the University of Colorado Denver Health Sciences Center.
Sullivan
Aimee E
AE
Drs. Miklowitz, George, Taylor and Ms. Sullivan are with the University of Colorado; Drs. Axelson and Birmaher are with the University of Pittsburgh School of Medicine; and Drs. Miklowitz, Schneck, and Dickinson are with the University of Colorado Denver Health Sciences Center.
Dickinson
L Miriam
LM
Drs. Miklowitz, George, Taylor and Ms. Sullivan are with the University of Colorado; Drs. Axelson and Birmaher are with the University of Pittsburgh School of Medicine; and Drs. Miklowitz, Schneck, and Dickinson are with the University of Colorado Denver Health Sciences Center.
Birmaher
Boris
B
Drs. Miklowitz, George, Taylor and Ms. Sullivan are with the University of Colorado; Drs. Axelson and Birmaher are with the University of Pittsburgh School of Medicine; and Drs. Miklowitz, Schneck, and Dickinson are with the University of Colorado Denver Health Sciences Center.
D000293:Adolescent; D000339:Affect; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D003142:Communication; D004359:Drug Therapy, Combination; D004493:Education; D019260:Expressed Emotion; D054541:Family Conflict / Q000523:psychology; D005196:Family Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010353:Patient Education as Topic; D011340:Problem Solving; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016896:Treatment Outcome
D018692:Antimanic Agents; D011619:Psychotropic Drugs