Weinstein Sally M, Henry David B, Katz Andrea C, Peters Amy T, West Amy E
University of Illinois at Chicago, Chicago, IL.
University of Illinois at Chicago, Chicago, IL.
J Am Acad Child Adolesc Psychiatry. 2015 Feb;54(2):116-25. doi: 10.1016/j.jaac.2014.11.007. Epub 2014 Nov 22.
Prior work has demonstrated the efficacy of child- and family-focused cognitive-behavioral therapy (CFF-CBT) versus enhanced treatment as usual (TAU; unstructured psychotherapy) for pediatric bipolar disorder (PBD). The current study builds on primary findings by examining baseline child, parent, and family characteristics as moderators of symptom response trajectories.
A total of 69 youth aged 7 to 13 years (mean = 9.19 years, SD = 1.61 years) with DSM-IV-TR bipolar I, II, or not otherwise specified (NOS) were randomly assigned, with family members, to CFF-CBT or TAU. Both treatments consisted of 12 weekly sessions and 6 monthly booster sessions. Participants were assessed at baseline, 4, 8, and 12 weeks, and 6-month follow-up on mania and depression symptoms and overall psychiatric severity. Parents and youth also provided self-report data on baseline characteristics.
CFF-CBT demonstrated greater efficacy for youth depressive symptoms relative to TAU for parents with higher baseline depressive symptoms and lower income, and marginally for families with higher cohesion. In addition, youth with lower baseline depression and youth with higher self-esteem showed a poorer response to TAU versus CFF-CBT on mania symptom outcomes. Age, sex, baseline mania symptoms, comorbidity, and suicidality did not moderate treatment response.
Results indicate that CFF-CBT was relatively immune to the presence of treatment moderators. Findings suggest the need for specialized treatment to address symptoms of PBD in the context of parental symptomatology and financial stress.
先前的研究已证明，针对儿童双相情感障碍（PBD），以儿童和家庭为中心的认知行为疗法（CFF-CBT）比强化常规治疗（TAU；非结构化心理治疗）更有效。本研究基于主要研究结果，考察基线时儿童、父母和家庭特征作为症状反应轨迹调节因素的情况。
共有69名7至13岁（平均=9.19岁，标准差=1.61岁）的青少年，根据《精神疾病诊断与统计手册》第四版（DSM-IV-TR）诊断为双相I型、II型或未特定指明（NOS），他们与家庭成员一起被随机分配接受CFF-CBT或TAU治疗。两种治疗均包括每周12次治疗课程和每月6次强化课程。在基线、第4、8和12周以及6个月随访时，对参与者的躁狂和抑郁症状以及整体精神疾病严重程度进行评估。父母和青少年还提供了关于基线特征的自我报告数据。
对于基线抑郁症状较高且收入较低的父母，以及凝聚力较高的家庭，CFF-CBT相对于TAU在青少年抑郁症状方面显示出更大的疗效。此外，基线抑郁程度较低的青少年和自尊心较高的青少年在躁狂症状结果方面，相对于CFF-CBT，对TAU的反应较差。年龄、性别、基线躁狂症状、共病和自杀倾向并未调节治疗反应。
结果表明，CFF-CBT相对不受治疗调节因素的影响。研究结果表明，在父母有症状和经济压力的情况下，需要专门的治疗来解决PBD的症状。
