Family focused therapy (FFT), developed by David Miklowitz, a professor of psychiatry at the University of California, Los Angeles, has been effective in treating early syndromes that sometimes lead to bipolar disorder (including depression, anxiety, or BP-NOS) in children at high risk for bipolar disorder because of a family history that includes bipolar disorder in a first degree relative. There are 8 key ingredients to family focused therapy.
- Consistent monitoring of the illness and developing an early warning system with a plan for responding if early symptoms emerge
- Stress management
- Development of a relapse prevention plan
- Emphasis on sleep hygiene and the importance of regular sleep patterns
- Work on medication adherence
- Development of self-regulatory skills
- Improvement of family relationships
- Avoidance of substances of abuse
In research published since 2008, our Editor-in-Chief Robert M. Post and colleagues in the Bipolar Collaborative Network have compared patients with bipolar disorder in the United States to those in Germany and the Netherlands. Compared to the European sample, patients in the US have more genetic vulnerability to bipolar disorder (by having a parent with bipolar disorder), earlier onsets of their illness, more complicated courses of illness, greater treatment resistance, and more medical comorbidities. Patients in the US also have more psychosocial stress.
The researchers are now turning their attention to these psychosocial vulnerabilities, and in a new paper that will be published in Psychiatry Research (late in 2013 or early in 2014), the authors show that patients in the US had more stressors both in childhood and just prior to the onset of their illness. Childhood stressors analyzed in the study were verbal abuse, physical abuse, and sexual abuse. Stressors in adulthood included indicators of a lack of social support, troubles with finances or employment, lack of access to health care, and medical comorbidities.
The stressors patients experienced just prior to their most recent episode of bipolar illness were related to: stressors in childhood, an earlier age of illness onset, anxiety and substance abuse comorbidity, lower income, both parents having an affective illness such as depression, and feeling more stigma.
The new research suggests that for patients with bipolar disorder in the US, adverse life events in childhood and later in life are more prevalent than they are for patients in the Netherlands or Germany. Earlier and more effective approaches to these stressors, such as the Family-Focused Therapy developed by David Miklowitz and Kiki Chang, could potentially slow the onset or progression of bipolar illness in this country.
Family Environment, Cognitive Functioning, and Quality of Life Among Depressed Adolescents with Bipolar Disorder
At the 2012 meeting of the American Academy of Child and Adolescent Psychiatry, Arman Danielyan presented a poster on psychosocial, cognitive, and behavioral characteristics of youth in a depressive phase of bipolar disorder. These adolescents had lower scores on a variety of measures.
Adolescents with bipolar depression had significantly lower scores on 7 of 10 family environment scales measuring the quality of family interaction, communication, and emotional tone. They also exhibited significant impairment in cognitive function, particularly executive functioning, and all domains of psychosocial health were substantially lower than US normative data.
The authors concluded that bipolar depression affects multiple domains of adolescents’ lives including their cognitive, psychosocial, and family functioning. This suggests that the involvement of the whole family in the treatment process would be beneficial.
The impaired cognitive functioning these young people face is associated with lower quality of life, and ways of addressing this better are clearly needed.
Editor’s Note: In a previous BNN we reported on the efficacy of Family Focused Therapy (FFT), which was pioneered by David Miklowitz. This therapy is effective for adolescents and adults with bipolar disorder and for adolescents who are at high risk for the disorder because of two factors: having a parent with the disorder and having preliminary symptoms of bipolar disorder not otherwise specified (BP-NOS), depression, or an anxiety disorder. Kiki Chang, a respected authority on child and adolescent psychiatry, recommends FFT for children and adolescents with bipolar disorder and those at high risk for it.