Early intervention for youth at high risk for bipolar disorder: A multisite randomized trial of family-focused treatment

David J. Miklowitz, Christopher D. Schneck, Patricia D. Walshaw, Amy S. Garrett, Manpreet K. Singh, Catherine A. Sugar, Kiki D. Chang

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Aims: Despite the considerable public health impact of bipolar disorder (BD), no psychosocial interventions have been systematically evaluated in its early prodromal stages. We describe the rationale, design and analytic methods for a 3-site randomized trial of family-focused treatment for youth at high risk (FFT-HR) for BD. Methods: Participants (ages 9-17 years) have a diagnosis of unspecified BD or major depressive disorder, current mood symptoms and at least one first- or second-degree relative with a lifetime history of BD I or II. Participants are randomly assigned to FFT-HR (12 sessions in 4 months of family psychoeducation and skills training) or enhanced care (EC; 6 individual and family sessions over 4 months), with pharmacotherapy provided as needed. A subset of participants undergo pre- and post-treatment functional MRI (fMRI) scans while performing face-rating and family problem-solving tasks designed to activate corticolimbic circuitry. Independent evaluators assess participants’ status every 4 to 6 months for up to 4 years. Results: We hypothesize that FFT-HR will be more effective than EC in reducing the severity of mood symptoms (primary outcome) and the hazard of a first manic episode (secondary) over 4 years. Secondarily, we will explore whether FFT-HR is associated with greater decreases in amygdala activation and increases in dorsolateral, ventrolateral or anterior medial prefrontal cortex activation from pre- to post-treatment. Clinical characteristics of 133 subjects enrolled at baseline are described. Conclusions: This study will test a novel intervention to reduce the early symptoms of BD, and identify neural and behavioural mechanisms that may help refine future treatments.

Original languageEnglish (US)
Pages (from-to)208-216
Number of pages9
JournalEarly Intervention in Psychiatry
Issue number2
StatePublished - Apr 2019


  • expressed emotion
  • family therapy
  • mania
  • neuroimaging
  • prodromal

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Phychiatric Mental Health


Dive into the research topics of 'Early intervention for youth at high risk for bipolar disorder: A multisite randomized trial of family-focused treatment'. Together they form a unique fingerprint.

Cite this