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David J. Miklowitz, PhD; Elizabeth L. George, PhD; Jeffrey A. Richards, MA; Teresa L. Simoneau, PhD; Richard L. Suddath, MD

Arch Gen Psychiatry. 2003;60:904-912.

Background  Bipolar patients are at risk for relapses of their illness even when undergoing optimal pharmacotherapy. This study was performed to determine whether combining family-focused therapy (FFT) with pharmacotherapy during a postepisode interval enhances patients' mood stability during maintenance treatment.

Methods  In a randomized controlled trial, 101 bipolar patients were assigned to FFT and pharmacotherapy or a less intensive crisis management (CM) intervention and pharmacotherapy. Outcome assessments were conducted every 3 to 6 months for 2 years. Participants (mean ± SD age, 35.6 ± 10.2 years) were referred from inpatient or outpatient clinics after onset of a manic, mixed, or depressed episode. FFT consisted of 21 sessions of psychoeducation, communication training, and problem-solving skills training. Crisis management consisted of 2 sessions of family education plus crisis intervention sessions as needed. Both protocols lasted 9 months. Patients received pharmacotherapy for 2 study years. Main outcome measures included time to relapse, depressive and manic symptoms, and medication adherence.

Results  Rates of study completion did not differ across the FFT (22/31, 71%) and CM groups (43/70, 61%). Patients undergoing FFT had fewer relapses (11/31, 35%) and longer survival intervals (mean ± SD, 73.5 ± 28.8 weeks) than patients undergoing CM (38/70, 54%; mean ± SD, 53.2 ± 39.6 weeks; hazard ratio, 0.38; 95% confidence interval, 0.20-0.75; P = .003; intent to treat). Patients undergoing FFT showed greater reductions in mood disorder symptoms and better medication adherence during the 2 years than patients undergoing CM.

Conclusion  Combining family psychoeducation with pharmacotherapy enhances the postepisode symptomatic adjustment and drug adherence of bipolar patients.

From the Department of Psychology, University of Colorado, Boulder (Drs Miklowitz, George, Simoneau, and Suddath and Mr Richards), and Department of Psychiatry, University of Colorado Health Sciences Center, Denver (Dr Suddath).

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