Magazine article Clinical Psychiatry News

Family-Focused Therapy May Help Bipolar Teens

Magazine article Clinical Psychiatry News

Family-Focused Therapy May Help Bipolar Teens

Article excerpt

PHOENIX, ARIZ. -- Family-focused therapy, which has been shown to be a valuable adjunct to medication in the treatment of adult bipolar disorder, may have particular applicability to adolescents, David Miklowitz, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

Certain modifications in the approach, such as the use of developmentally appropriate terminology, and direct support for parents' behavioral management efforts are needed to tailor the therapy to this population, said Dr. Miklowitz of the University of Colorado, Boulder.

A strong correlation between family factors and the course of recurrent mood disorders has been observed in both adults and children. On a practical level, it is difficult to dispense mood stabilizers safely and consistently in a chaotic family environment, and to attend to such matters as blood-level monitoring and regular physician visits.

Expressed emotion within the family-- an index of critical and hostile communication and emotional overinvolvement-- has been linked to relapse rates in bipolar disorder, as in schizophrenia. In one series that followed 23 patients for 9 months after resolution of an acute episode, 9 of the 10 families that were high in expressed emotion had relapses, compared with 7 of 13 families of low expressed emotion, Dr. Miklowitz said.

Family-focused therapy (FFT) is a modality developed to address family issues, particularly communication and problem solving, in the context of bipolar disorder. It is typically given in 21 outpatient sessions, over a period of 9 months, beginning as the patient is recovering from an acute episode.

Dr. Miklowitz characterized FFT as "an end run around expressed emotion." Rather than telling family members to be less critical, hostile, or involved, it teaches positive communication and problemsolving skills. …

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