title: Pharmacotherapy and family-focused treatment for adolescents with bipolar I and II disorders: a 2-year randomized trial.
abstract: OBJECTIVE
  Previous studies have found that family-focused treatment is an effective adjunct to pharmacotherapy in stabilizing symptoms in adult bipolar disorder. The authors examined whether pharmacotherapy and family-focused treatment for adolescents with bipolar disorder was more effective than pharmacotherapy and brief psychoeducation (enhanced care) in decreasing time to recovery from a mood episode, increasing time to recurrence, and reducing symptom severity over 2 years.
  
  
  METHODS
  A total of 145 adolescents (mean age, 15.6 years) with bipolar I or II disorder and a DSM-IV-TR manic, hypomanic, depressive, or mixed episode in the previous 3 months were randomly assigned, with family members, either to pharmacotherapy and family-focused treatment, consisting of psychoeducation (i.e., recognition and early intervention with prodromal symptoms), communication enhancement training, and problem-solving skills training, delivered in 21 sessions over 9 months; or to pharmacotherapy and three weekly sessions of enhanced care (family psychoeducation). Independent evaluators assessed participants at baseline, every 3 months during year 1, and every 6 months during year 2, using weekly ratings of mood.
  
  
  RESULTS
  Twenty-two participants (15.2%) withdrew shortly after randomization. Time to recovery or recurrence and proportion of weeks ill did not differ between the two treatment groups. Secondary analyses revealed that participants in family-focused treatment had less severe manic symptoms during year 2 than did those in enhanced care.
  
  
  CONCLUSIONS
  After an illness episode, intensive psychotherapy combined with best-practice pharmacotherapy does not appear to confer advantages over brief psychotherapy and pharmacotherapy in hastening recovery or delaying recurrence among adolescents with bipolar disorder.
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Schneck
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: George
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sugar
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kowatch
authors.forename: Melissa P
authors.initials: MP
authors.lastname: DelBello
authors.forename: David A
authors.initials: DA
authors.lastname: Axelson
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000628:therapy*; D005196:Family Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents