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Abstract
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