Family Treatment for Bipolar Disorder: Family Impairment by Treatment Interactions
J Clin Psychiatry 2008;69(5):732-740
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: There is a clear need for psychosocial treatments
to supplement pharmacotherapy for bipolar disorder. In this study, the efficacy
of 2 forms of adjunctive family intervention were compared to pharmacotherapy
alone. In addition to evaluating overall differences between treatments, a
chief goal was to examine whether family impairment levels moderated the
effects of family intervention on outcome.
Method: Ninety-two patients diagnosed with bipolar I disorder
(according to DSM-III-R) were randomly assigned to receive (1) pharmacotherapy
alone, (2) family therapy + pharmacotherapy, or (3) multi-family
psychoeducational group + pharmacotherapy. Treatments and assessments continued
for up to 28 months. Primary outcome measures were number of episodes per year
and percentage of time symptomatic throughout the entire follow-up period. The
study was conducted from September 1992 through March 1999.
Results: No significant main effects were found for treatment
condition. Thus, for the total sample, the addition of a family intervention
did not improve outcome. However, there were significant treatment condition by
family impairment interactions (p < .05). In patients from families with high
levels of impairment, the addition of a family intervention (family therapy or
psychoeducational group) resulted in a significantly improved course of
illness, particularly the number of depressive episodes (p < .01) and
proportion of time spent in a depressive episode (p < .01). These effects were
relatively large (Cohen d = 0.7-1.0), with patients receiving either family
intervention having roughly half the number of depressive episodes and amount
of time spent depressed as those receiving pharmacotherapy alone. In contrast,
for patients from low-impairment families, the addition of a family
intervention did not improve course of illness.
Conclusions: Our findings build on previous literature
suggesting the importance of treatment matching within the mood disorders and
suggest that the utility of adding family interventions for bipolar patients
and their families may depend upon the family's level of impairment.