The importance of family-based treatments for bipolar spectrum disorders and psychotic disorders.

Abstract Background. Despite apparent clinical remission, individuals with psychotic disorders often experience significant impairments across functional domains. Thus, there is a need to search beyond management of core symptoms to optimize treatment outcomes. Affective dysregulation is considered a risk factor for poor clinical and functional outcomes in many mental disorders, but research investigating such features in psychosis, particularly in schizophrenia, is limited. We aimed to investigate the level of affective lability (AL) in participants with schizophrenia- and bipolar spectrum disorders (n = 222) compared to healthy controls (n = 140), as well as clinical correlates of AL in the diagnostic groups. Methods. The Affective Lability Scale (ALS-SF) was used to measure total score of AL and subscores covering the domains of anxiety/depression, depression/elation, and anger. An analysis of covariance was performed to compare the ALS-SF total score between groups, correcting for potential confounders, as well as standard multiple regression analyses for diagnosis-specific investigations of the relationship between AL and demographic and clinical features. Results. Both the schizophrenia- and bipolar spectrum group had significantly higher ALS-SF total score compared to controls (p < 0.001), and no significant differences between the patient groups were found. In the schizophrenia group, current psychotic and depressive symptoms were significantly and independently associated with AL (p = 0.012 and p = 0.024, respectively). Conclusions. The findings indicate that AL is elevated in psychotic disorders and that it transcends diagnostic boundaries. Further research into the causal relationship between psychotic and affective symptoms and AL, as well as its role as a potential therapeutic target in psychosis spectrum disorders, is warranted.

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Flexible Applications of Family-Based Therapy for Youth with Bipolar Spectrum Disorders

Flexibility within Fidelity ◽

10.1093/med-psych/9780197552155.003.0010 ◽

2021 ◽

pp. 157-174

Author(s):

Haley M. Brickman ◽

Mary A. Fristad

Keyword(s):

Negative Impact ◽

Behavioral Therapy ◽

Psychosocial Treatment ◽

Bipolar Spectrum ◽

Optimal Care ◽

Bipolar Spectrum Disorders ◽

Individualized Approach ◽

Spectrum Disorders ◽

Family Based ◽

Flexible Applications

Bipolar spectrum disorders (BPSD) affect approximately 3.9% of youth and are associated with meaningful impairments across social, academic, and family domains. Early psychosocial treatment, in conjunction with psychotropic intervention, can ameliorate the negative impact of symptoms by equipping youth and their families with knowledge and skills to promote understanding and management of the disorder, leading to improved short- and long-term outcomes. Family-focused treatment for adolescents (FFT-A), family-focused cognitive behavioral therapy (CFF-CBT), and psychoeducational psychotherapy (PEP) represent a well-established class of manual-based interventions that have been found to improve mood symptoms and family functioning through the use of family psychoeducation and skill building. We detail and discuss the core components of these interventions, with a specific focus on how treatment components can be successfully adapted and delivered to ensure an individualized approach for optimal care. Flexibility is further illustrated by a depiction of ways in which PEP has been adapted to meet practical needs of families and clinicians while maintaining fidelity to the intervention.

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