August 18, 2005

Family Support Helps Bipolar Teens

University of Colorado at Boulder Study Suggests Strong Family Support Helpful in Treating Teen Bipolar Disorder

Bipolar adolescents, saddled with mood swings far more severe than the raging hormones and mood changes common to healthy teens, may have a strong ally in their fight to control the disease.

Preliminary results from studies conducted at the University of Colorado at Boulder show that teen-agers who were treated with a combination of mood-stabilizing medication and family-focused therapy showed improvements in depression and mania symptoms. Behavioral problems also improved during the combined treatment, according to CU-Boulder psychology Professor David Miklowitz, who led the study.

Miklowitz discussed the results during the American Psychological Association's annual convention held in Washington, D.C., Aug. 18-21. Medication is the first line of defense against bipolar disorder, also called manic depression. The disease is caused by a biochemical imbalance in the brain and affects an estimated three million Americans, 20 to 40 percent of whom have their first onset in childhood or adolescence.

Bipolar disorder in teen-agers often rears its head in the form of extreme irritability, according to Miklowitz. "It's tough to diagnose in teen-agers, because teens are often moody anyway," Miklowitz said. "But teens with bipolar disorder have extreme irritability, so these can be very trying times for them and their families."

The goal of the family-focused therapy is for the patient and his or her parents and siblings to understand the disease and to learn to cope with it, Miklowitz said. He said this includes recognizing early warning signs that an episode may be about to occur.

Keeping the family unit on the same page through communication and problem solving is also part of it, as well as learning to manage stress and take medications appropriately. Uncontrolled, all of these factors can lead to more severe episodes.

"Families often have a tough time recognizing that this is a disease, and often times kids are misdiagnosed," Miklowitz said. While the disease itself only afflicts the child, the fallout affects the entire family unit.

"You often see significant family conflict associated with mood episodes making it so stressful that something like having a meal together is almost impossible," Miklowitz said. "Left untreated, severe episodes can even lead to suicide attempts."

During a one-year uncontrolled study, 20 bipolar adolescents were treated with mood-stabilizing medications and attended 21 family-counseling sessions over nine months. During that period, their depression and mania symptoms and behavioral problems improved, he said.

Results from an ongoing randomized controlled study will clarify whether adolescents suffering from bipolar disorder improved under the combined treatment method over a two-year period, compared to those who received only medication and a brief education about the disorder.

In earlier studies Miklowitz and colleagues showed that adult patients who received medication and a family-focused treatment program had fewer episodes of the disease, and longer delays before relapses, than those receiving medication and standard treatment.

Miklowitz described the treatment program in the 1997 book "Bipolar Disorder: A Family Focused Treatment Approach." He was recently honored at the International Conference on Bipolar Disorder with the Mogens Schou Award for Research. The award recognized Miklowitz's work to develop effective approaches to educate families on how to cope with bipolar disorder and the many factors contributing to control of the disease and relapse.

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