Family Focused Therapy

October 22, 2013 · Posted in Current Treatments · Comment 

family therapy

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.

  1. Consistent monitoring of the illness and developing an early warning system with a plan for responding if early symptoms emerge
  2. Stress management
  3. Development of a relapse prevention plan
  4. Emphasis on sleep hygiene and the importance of regular sleep patterns
  5. Work on medication adherence
  6. Development of self-regulatory skills
  7. Improvement of family relationships
  8. Avoidance of substances of abuse

 

Psychotherapy Prevents Recurrence of Depression

October 17, 2013 · Posted in Current Treatments · Comment 

happy woman

New research shows that psychotherapy lowers the risk of relapse in unipolar major depression more than “treatment as usual” does, and also heads off depression in children at high risk.

At the 2013 meeting of the American Psychiatric Association, researcher Pim Cuijpers reviewed 32 trials of cognitive behavior therapy, intensive behavioral therapy, and problem solving therapy used for the prevention of depression and found that these therapies were associated with a 21% lower risk of relapse compared to treatment as usual.

There were five critical elements that made these therapies useful: they supported coping with depression, and they included exercise, mindfulness, internet-based cognitive behavior therapy, and problem solving.

Among those who presented at the meeting, Greg Clarke of Kaiser Permanente, Oregon discussed an 8-week course on coping with stress given to a group of adolescents (aged 14 to 16) who had four times the normal risk of developing depression because each had a parent with depression. Clarke found a significant reduction in depression among the adolescents who received therapy compared to controls.

Insomnia can be a precursor to a first depression or to recurrent depression. Cognitive behavior therapy was more effective in improving sleep than a comparative sleep hygiene course.

Researcher Judy Garber presented data showing that cognitive behavior therapy was effective in 13- to 17-year-olds who had a parent with depression and had themselves had a prior depression or were currently sub-syndromal. The effect of the therapy was only significant if the parent was not depressed at intake.

Parent-Child Therapy Technique Could Be Useful for Depression in Very Young Children

May 2, 2012 · Posted in Potential Treatments · Comment 

LubyThere are few treatments approved by the Federal Drug Administration for the treatment of depression in very small children.  But a new therapeutic technique parents can use with their children is being studied.

According to an article published by the Brain and Behavior Research Foundation,

Now, a novel approach called Parent Child Interaction Therapy-Emotion Development (PCIT-ED), being tested by Brain & Behavior Research Foundation Independent Investigator Grantee Joan Luby, M.D., and colleagues at Washington University in St. Louis, has shown promise in an early trial of improving mood and behavior in very young children with depression. The results of the pilot study were reported online on Oct. 31, 2011 in the Journal of Child Psychology and Psychiatry.

PCIT-ED is a dyadic psychosocial intervention with two components. The PCIT part is aimed at strengthening the parent-child relationship by teaching positive play techniques and training parents in ways to handle children’s noncompliant and disruptive behavior. PCIT has previously been shown to be effective for treating disruptive disorders among preschoolers. The new ED component was designed to help parents enhance their children’s ability to recognize their own emotions as well as emotions in others and to more effectively regulate intense emotions.

[Editor’s Note.: our emphasis]

RTMS Parameters

November 18, 2011 · Posted in Current Treatments · Comment 

rTMSAs we wrote yesterday, repeated transcranial magnetic stimulation (rTMS) is a treatment in which a magnetic field is applied to a patient’s head, where it is able to affect tissue 2-3 centimeters into the brain.  The major studies of rTMS, by O’Reardon and colleagues (2007) and George et al. (2010), were performed with patients who were medication-free during the course of rTMS treatment. However, it is routine clinical practice to use rTMS as an adjunctive treatment to ongoing antidepressant therapy, and in these cases, response rates appear to be close to 50%, even in patients with considerable treatment resistance to prior antidepressants.

Using the FDA-approved parameters, treatment is typically delivered with with an rTMS machine that stimulates the left prefrontal cortical area of the brain at a stimulation intensity of 120% of the patient’s motor threshold at a frequency of magnetic impulses of 10 per second or 10 Hz.  The motor threshold is the intensity of stimulation necessary to cause the thumb to move when the motor cortex is stimulated, but the treatment is given over the frontal cortex which does not produce any movements or other sensations.

Each treatment lasts for about 20 minutes and does not require any anesthesia or premedication. The patient is awake and alert during the procedure, and cognitive side effects are minimal.  Patients occasionally experience some pain from contraction of the scalp muscles under the magnet.

The rapid reversal of the magnetic field occurring ten times per second induces electrical stimulation of the brain at the same frequency and causes discharge of neurons. High frequency (at 10 or 20Hz) neuronal activity appears to increase activity (blood flow or metabolism) in the brain, while lower frequency stimulation, such as at 1 Hz, appears to decrease brain activity. In both cases, the effects last at least 48 hours after the last of a two- or three-week series of treatments.  RTMS increases brain-derived neurotrophic factor (BDNF) in the brain, and BDNF is released when nerves fire at a fast frequency. The release of BDNF appears to be necessary for long-term learning and memory.

Sitting passively versus receiving therapy during rTMS

In clinical practice, most treatments are administered by a technician. However, in some instances, clinicians engage patients in forms of active psychotherapy while they are receiving the rTMS. Read more

Preventing Recurrent Mood Episodes

January 5, 2011 · Posted in Current Treatments · Comment 

Psychotherapy and psychoeducational approaches, long-term psychopharmacology, and combination therapy all play a role in preventing recurrent mood episodes.

Psychotherapeutic and Psychoeducational Approaches Are Critical

A number of studies presented at the 4th Biennial Conference of the International Society for Bipolar Disorders in Sao Paulo, Brazil in March indicated that cognitive-behavioral therapy (CBT) and individual and group psychoeducational approaches enhance both short- and long-term outcomes for patients with bipolar illness. These studies add to an already substantial literature that shows that focused psychotherapies (such as cognitive/behavioral, interpersonal, and social rhythms therapies) and psychoeducation are superior to treatment as usual.

psychotherapy

These therapies can provide a variety of approaches to stress management and reduction, and can enhance family and interpersonal communication. Another way these focused psychotherapeutic approaches help patients is by demonstrating the benefits of effective long-term preventive treatment and encouraging its consistent use.

Without consistent prophylactic treatment, patients are at high risk for recurrences and their subsequent psychosocial and neurobiological consequences. Greater number of prior episodes is associated with an increased risk of psychosocial dysfunction, treatment resistance, cognitive dysfunction, medical comorbidities, and even dementia in old age.

After the jump: preventive psychopharmacology and combination therapy. Read more

Dialectical Behavior Therapy Effective for Adolescents with Bipolar Disorder

October 29, 2010 · Posted in Current Treatments · Comment 

As we posted yesterday, therapeutic approaches appear necessary for childhood-onset bipolar disorder.  In a poster at the Pediatric Bipolar Conference in Cambridge, Massachusetts in March, Tina Goldstein of Western Psychiatric Institute in Pittsburgh presented an open study indicating that dialectical behavior therapy (DBT) was effective for adolescents with bipolar disorder. This is the second study that has produced these results. In DBT, patients are taught coping skills and mindfulness in order to break the cycle of responding to dysregulated emotions with problematic behaviors.

Read more

Psychotherapy Necessary for Bipolar Disorder and Severe Mood Dysregulation in Children

October 28, 2010 · Posted in Current Treatments · Comment 

TherapyDr. Janet Wozniak of Massachusetts General Hospital initiated a survey, both at MGH and in the field, to ascertain practitioners’ experience with individual and family psychotherapeutic and educational approaches to childhood-onset bipolar illness. These types of approaches appear fundamental to treating children or families in which there is bipolar illness.

It was the view of Wozniak, her survey, and many other investigators in attendance at the Pediatric Bipolar Conference in Cambridge, Massachusetts in March that such psychotherapeutic approaches are needed, and often recommended, but the availability of effective treatment and of therapists skilled in administering any of these psychotherapies in children is often lacking.

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