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Early psychosocial intervention for youth at risk for bipolar I or II disorder: a one-year treatment development trial


  • Http:// identifier: NCT00943085.

  • DJM has received funding from the National Alliance for Research on Schizophrenia and Depression (NARSAD), the Danny Alberts Foundation, the National Institute of Mental Health (NIMH), and the Robert L. Sutherland Foundation; and royalties from Guilford Press and John Wiley & Sons. KDC has received research funding from NARSAD, NIMH, and GlaxoSmithKline; and has received honoraria from GlaxoSmithKline, Eli Lilly & Co., Bristol-Myers Squibb, and Merck. DOT, ELG, MKS, CDS, LMD, MEH, and JG do not have any conflicts of interest to report.

Corresponding author:
David J. Miklowitz, Ph.D.
Division of Child and Adolescent Psychiatry
UCLA Semel Institute for Neuroscience and Human Behavior
David Geffen School of Medicine at UCLA
760 Westwood Plaza, Room 58-217
Los Angeles, CA 90024-1759, USA
Fax: +1-310-206-4446


Miklowitz DJ, Chang KD, Taylor DO, George EL, Singh MK, Schneck CD, Dickinson LM, Howe ME, Garber J. Early psychosocial intervention for youth at risk for bipolar I or II disorder: a one-year treatment development trial.
Bipolar Disord 2011: 13: 67–75. © 2011 The Authors.
Journal compilation © 2011 John Wiley & Sons A/S.

Objectives:  Previous studies have identified behavioral phenotypes that predispose genetically vulnerable youth to a later onset of bipolar I or II disorder, but few studies have examined whether early psychosocial intervention can reduce risk of syndromal conversion. In a one-year open trial, we tested a version of family-focused treatment adapted for youth at high risk for bipolar disorder (FFT-HR).

Methods:  A referred sample of 13 children (mean 13.4 ± 2.69 years; 4 boys, 9 girls) who had a parent with bipolar I or II disorder participated at one of two outpatient specialty clinics. Youth met DSM-IV criteria for major depressive disorder (n = 8), cyclothymic disorder (n = 1), or bipolar disorder not otherwise specified (n = 4), with active mood symptoms in the past month. Participants were offered FFT-HR (12 sessions in four months) with their parents, plus psychotropic medications as needed. Independent evaluators assessed depressive symptoms, hypomanic symptoms, and global functioning at baseline and then every four months for one year, with retrospective severity and impairment ratings made for each week of the follow-up interval.

Results:  Families were mostly adherent to the treatment protocol (85% retention), and therapists administered the FFT-HR manual with high levels of fidelity. Youth showed significant improvements in depression, hypomania, and psychosocial functioning scores on the Adolescent Longitudinal Interval Follow-up Evaluation. They also showed significant improvements in Young Mania Rating Scale and Children’s Depression Rating Scale scores.

Conclusions:  FFT-HR is a promising intervention for youth at high risk for BD. Larger-scale randomized trials that follow youth into young adulthood will be necessary to determine whether early psychosocial intervention can reduce the probability of developing bipolar I or II disorder among genetically vulnerable youth.