Changes in Intrinsic Brain Connectivity in Family-Focused Therapy Versus Standard Psychoeducation Among Youth at High Risk for Bipolar Disorder. Journal of the American Academy of Child and Adolescent Psychiatry Singh, M. K., Nimarko, A. F., Garrett, A. S., Gorelik, A. J., Roybal, D. J., Walshaw, P. D., Chang, K. D., Miklowitz, D. J. 2020


OBJECTIVE: We compared intrinsic network connectivity in symptomatic youth at high risk (HR) for bipolar disorder (BD) and healthy comparison (HC) youth, and, in HR youth, investigated treatment-related changes in intrinsic connectivity following family focused therapy for high-risk youth (FFT-HR) versus standardized family psychoeducation.METHOD: HR youth (N=34; age 9-17 years; mean 14 years, 56% girls) with depressive and/or hypomanic symptoms and at least one first- or second-degree relative with BD I or II were randomly assigned to 4 months of FFT-HR (12 sessions of psychoeducation, communication, and problem-solving skills training) or Enhanced Care (EC; 3 family and 3 individual psychoeducation sessions). Before and after 4-months of treatment, participants underwent resting state functional magnetic resonance imaging (rs-fMRI). A whole brain independent component analysis compared rs-fMRI networks in HR youth and 30 age-matched HC youth at a pretreatment baseline. Then, we identified pretreatment to post-treatment (4-month) changes in network connectivity in HR youth receiving FFT-HR (n=16) or EC (n=18) and correlated these changes with depression improvement.RESULTS: At baseline, HR youth had greater connectivity between the ventrolateral prefrontal cortex (VLPFC) and the anterior default mode network (aDMN) than did HCs (p=.004). Over 4 months of treatment, FFT-HR-assigned HR youth had increased VLPFC-aDMN connectivity from pre- to post-treatment (p=.003), whereas HR youth in EC showed no significant change over time (p=.11) (treatment by time interaction, [t(31)=3.33, CI 95% [0.27, 1.14], p=.002]. Reduction in depression severity over 4 months inversely correlated with enhanced anterior DMN (r= -.71) connectivity in the FFT-HR but not in the EC (r=-.07) group (z=-2.17, p=.015).CONCLUSION: Compared to standard psychoeducation, FFT-HR is associated with stronger connectivity between the VLPFC and aDMN, suggesting possible enhancements of self- and illness awareness and emotion regulation.

View details for DOI 10.1016/j.jaac.2020.07.892

View details for PubMedID 32745598