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NIMH Funds Research for Early Intervention in Childhood Bipolar Disorder

Science Update

NIMH recently approved funding to test the effectiveness of an early intervention in children at high risk for developing bipolar disorder. Though early in the research process, the long-term goal of this study is to reduce or delay the development of bipolar disorder in at-risk youth, heading off the effects of the disorder before it disrupts healthy development and functioning.

Family-focused therapy (FFT) involves teaching patients and their families about bipolar disorder and disease management, improving communication skills, and developing problem-solving skills. Past research has shown that FFT, when used with medication treatment, can help prevent recurrences and reduce symptoms in adults and teenagers diagnosed with bipolar disorder. The recently approved study aims to develop FFT for children, ages 9-17, at high risk for developing bipolar disorder. High risk indicates children who have some symptoms of bipolar disorder, but do not show all the symptoms required for a formal diagnosis, and have an immediate family member with bipolar disorder. Twelve children will participate in this phase of the study. The second phase will then compare FFT to treatment as usual, which includes any treatment prescribed by the patient's doctor. Children in both groups will receive medications if needed to help manage symptoms of bipolar disorder, although they do not have to take medications to participate. The researchers expect to include 40 high-risk children for this phase. Depending on the results of this three-year pilot study, a larger-scale trial may be developed.

"As they develop, children go through various learning experiences and developmental milestones," said Joel Sherrill, Ph.D., head of the NIMH Child and Adolescent Psychosocial Intervention Research Program. "Bipolar disorder can interrupt development, so if we can prevent or delay the onset of illness episodes, children with bipolar disorder might have a more typical developmental course."

The study will be conducted at the University of Colorado, led by David Miklowitz, Ph.D.; and Stanford University, led by Kiki Chang, M.D.

"We've known for a long time that bipolar disorder strongly impairs the functioning of the individual and causes considerable distress for the family," Dr. Miklowitz said. "Typically, a person undergoes treatment only after he or she is already diagnosed with bipolar disorder. This study is different in that it will help us determine whether we can minimize future impairments by intervening prior to the first episode."

The classic definition of bipolar disorder includes extreme, sustained mood swings that range from over-excited, elated moods and irritability—the manic phase of the disorder—to depression. In the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)—a large, national research study determining the best treatment practices for the disorder—of the first 1,000 participants enrolled, more than half of all cases began before age 18. Current research also suggests that onset during childhood is a sign of a more severe form of the disorder.