Psychoeducation Can Ameliorate Somatic and Manic Symptomatology in Youth at High-Risk for Bipolar Disorder: A Randomized-Controlled Study

Abstract

Background: Bipolar Disorder (BD) is a chronic, recurrent and potentially severe psychiatric disorder with relatively high prevalence rates and debilitating consequences. Delays in diagnosis and treatment of BD have been associated with longer depressive episodes, higher suicidality, shorter euthymic periods and poorer functioning in adulthood. For these reasons, early recognition of BD is clinically important. Given the high hereditary rates for 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. Psychoeducation is a core component of psychotherapeutical interventions such as cognitive-behavioral therapy (CBT), family focused therapy (FFT) and interpersonal and social rhythm therapy (IPSRT). Several studies which explored the effectiveness of CBT, FFT and IPSRT in HR youth reported positive out-comes; but previously explored prevention interventions 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 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). Results: Even though psychoeducation did not have effect on QoL of the high-risk population; overall reduction in somatic and manic symptom severity in CCSS-5 was more distinct for PE+ group compared to PE- group. Conclusion: Results from this study are, to an extent, in line with previous psychotherapeutic interventions done in symptomatic HR which include psychoeducation as a core component. In fact 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; but improvement in somatic symptomatology should be approached from a different angle. Overall reduction in somatic symptom severity of PE+ group that we found 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.