Psychoeducation Can Ameliorate Somatic and Manic Symptomatology in Youth at High-Risk for Bipolar Disorder: A Randomized-Controlled Study
Background: Given the high hereditary rates for bipolar disorder (BD), offspring of BD patients (high-risk [HR] group) are perfect candidates for research on early detection and prevention strategies. Psychoeducation is a structured and systematic intervention, in which the knowledge of the illness and its treatment is transferred to the patient and/or family in a didactic approach and it is a core component of psychotherapeutical interventions. Several studies which explored the effectiveness of these interventions in HR youth reported positive out-comes; but these were mainly focused on symptomatic HR and none of them were done among asymptomatic HR. Therefore with this study, we aimed to evaluate the effect of psychoeducational intervention on asymptomatic HR youth.
Methods: In this prospective randomized controlled study, total of 60 cases (aged between 11 – 18 years) were enrolled and randomized into two group as cases who received psychoeducational intervention (PE+) (n=30) and who did not receive psychoeducational intervention (PE-) (n=30) on the first visit (T0). Groups were evaluated regarding their psychiatric symptomatology and quality of life (QoL) using DSM-5 Level 1 Cross-cutting Symptom Scale Child Form (CCSS-5) and Pediatric Quality of Life Questionnaire throughout four interviews with 3-month intervals (T0 – T3). Total of 14 cases in PE+ and 10 cases in PE- group were diagnosed with at least one psychiatric disorder in the duration of the study and one case in PE+ dropped-out from the study without further notice; so total of 15 children in PE+ and 20 children in PE- group completed all of the interviews.
Results: Ages of PE+ group ranged between 10.58 and 17.58 years (mean[±SD]=14.80[±2.56]) and PE- group ranged between 10.83 and 17.25 years (mean[±SD]=13.83[±2.33]). Male participants comprised 66.67% of PE+ group and 56.67% of PE- group. There was no statistically significant difference between groups regarding age (p=0.096) and gender (p=0.426). Even though psychoeducation did not have effect on QoL of the high-risk population; overall reduction in somatic (p<0.001) and manic (p=0.026) symptom severity in CCSS-5 was more distinct for PE+ group compared to PE- group. There were no significant effects of psychoeducation on the other subscales of CCSS-5.
Conclusion: Improvement in affective symptomatology with CBT and longer remission periods with FFT can be explored in the same scope with the overall reduction in manic symptom severity we showed in PE+ group. Overall reduction in somatic symptom severity of PE+ group might be due to the positive effect of psychoeducation on family communication and problem-solving skill. However, there is no previous research indicating the presence of somatic symptoms/somatization disorders among HR youth; so whether somatic symptoms are the consequences of family conflict or a core component of prodromal phase of BD is still unclear. Studies state that psychological interventions are most effective if they are performed in the early stages of BD; therefore asymptomatic HR youth are critical for prevention strategies and more studies are needed in this population.
Keywords: bipolar disorder, high-risk, early intervention, psychoeducation