Goldstein Tina R, Fersch-Podrat Rachael K, Rivera Maribel, Axelson David A, Merranko John, Yu Haifeng, Brent David A, Birmaher Boris
1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
J Child Adolesc Psychopharmacol. 2015 Mar;25(2):140-9. doi: 10.1089/cap.2013.0145. Epub 2014 Jul 10.
The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP).
We recruited participants 12-18 years of age with a primary BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly over 1 year.
Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation.
DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for adolescents with BP. The DBT focus on commitment to treatment may be important for the treatment of early-onset BP. Larger controlled trials are needed to establish the efficacy of this approach, examine impact on suicidal behavior, and demonstrate cost effectiveness.
本研究旨在针对被诊断为双相情感障碍（BP）的青少年开展一项辩证行为疗法（DBT）与常规心理社会治疗（TAU）对比的试点随机试验。
我们从一家儿科专科诊所招募了年龄在12至18岁、主要诊断为双相情感障碍（I型、II型或未另行指定的操作性标准[NOS]）的参与者。符合条件的患者采用2:1随机分组结构，分为DBT组（n = 14）或常规心理社会治疗TAU组（n = 6）。所有患者均接受来自参与研究的精神科医生的药物管理。DBT在1年内包括36次治疗（18次个体治疗、18次家庭技能培训）。TAU是一种折衷的心理治疗方法，包括心理教育、支持性和认知行为技术。一名对治疗条件不知情的独立评估者在1年中每季度评估包括情感症状、自杀意念和行为、非自杀性自伤行为以及情绪失调等结果。
接受DBT治疗的青少年在1年中参加的治疗 sessions 明显多于接受TAU治疗的青少年，这可能反映出更高的参与度和留存率；两种治疗在青少年和家长中都被评为高度可接受。与接受TAU治疗的青少年相比，接受DBT治疗的青少年在随访期间抑郁症状明显较轻，自杀意念改善的可能性几乎是其三倍。模型表明，在接受DBT治疗的青少年随访期间，处于心境正常状态的周数效应量很大。虽然在治疗中躁狂症状或情绪失调方面两组之间没有差异，但接受DBT治疗的青少年（而非接受TAU治疗的青少年）在治疗前到治疗后在躁狂症状和情绪失调方面均有改善。
DBT作为药物治疗的辅助手段，在治疗患有双相情感障碍青少年的抑郁症状和自杀意念方面可能具有前景。DBT对治疗承诺的关注对于早发性双相情感障碍的治疗可能很重要。需要更大规模的对照试验来确定这种方法的疗效，研究对自杀行为的影响，并证明成本效益。
