Family-focused therapy (FFT), which was developed as an adjunctive treatment for bipolar disorder, involves the family and patient in all aspects of treatment and includes education, practicing open communication, and enhancing problem solving. The group that developed FFT has now conducted a randomised comparison of 4 months of FFT (12 sessions) or enhanced standard care (6 sessions; education and a mood management plan for patients only) in 127 children with active mood symptoms (mean age, 13).
Patients had diagnoses of major depression or subthreshold bipolar disorder (insufficient number or severity of symptoms to meet full criteria for bipolar disorder), and all had relatives with bipolar disorder. Pharmacotherapy was prescribed independent of psychotherapy.
At a median follow-up of 98 weeks, the groups did not differ in median time to recovery (23–24 weeks) from the index episode. However, among 90 recovered participants, the time to develop a new mood episode was significantly longer with FFT than enhanced care. After recovery, rates were higher for depressive episodes than manic/hypomanic ones. Conversion from major depression or subsyndromal bipolar disorder to syndromal bipolar disorder occurred in about 14% of patients and was predicted only by baseline manic symptoms.
FFT does not seem to influence recovery from an acute episode, but by improving primary relationships, it can add to mood stability and increase the family's ability to recognise and respond to early signs of relapse. The greater frequency and duration of FFT sessions, compared with standard care, might also be important. Whatever the treatment, families should be involved, and patients should be followed closely after improvement, especially for emergence of isolated hypomanic symptoms.