Investigation of the effects of family-focused therapy in the early period of bipolar disorder and psychotic disorder

Introduction: Bipolar disorder and schizophrenia are lifelong conditions that impose a significant burden on individuals, their families, and society as a whole. While these are distinct psychiatric disorders, they share commonalities such as overlapping symptoms, genetic and neurobiological factors, a chronic course, and substantial impairment in functionality. Recent follow-up studies have been focusing on the early stages of these disorders. In addition to pharmacological approaches, psychosocial interventions are increasingly employed for early diagnosis and treatment. Targeted early interventions are crucial as they have the potential to reduce psychosocial stress, the risk of progression, and detrimental neuroprogressive processes experienced by young individuals with symptoms. While intervention studies have primarily involved adults, more research is needed for children and adolescents. In addition to their impact on patients, bipolar disorder and schizophrenia also place a burden on their caregivers. The concept of family burden has gained significance due to the active role of families in caregiving. Psychosocial interventions for both the young person and their family can contribute to the functionality of these group. There is limited research comparing the effects of early interventions in psychotic and bipolar disorders. This study aimed to investigate the effects of family-focused therapy on individuals and their families in the early stages of these disorders. Specifically, it sought to assess the impact of family-focused therapy on the symptomatology of young individuals, family communication skills, coping abilities of young individuals, family burden, and quality of life. Method: In this study, we recruited the patients who met the criteria for Bipolar Disorder Type I-II, schizophreniform disorder, or schizophrenia and had achieved remission. The study was conducted at Dokuz Eylül University Faculty of Medicine, Department of Child and Adolescent Psychiatry and Dokuz Eylül University Faculty of Medicine, Department of Mental Health and Diseases. Participants included youth who agreed to take part, along with at least one parent. The study involved a total of 10 recent-onset individuals diagnosed with bipolar disorder and 10 with psychotic disorders, along with their parents who completed family-focused therapy sessions. Clinical assessments were conducted using the Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Scale for the Assessment of Positive Symptoms (SAPS), Brief Negative Symptom Scale (BNSS), Personal and Social Performance Scale (PSP), and Scale of Unawareness of Mental Disorder (SUMD). Additionally, young individuals completed the Coping Strategies Scale Short Form (Brief-COPE), Emotion Expression Scale (KDDS), World Health Organization Quality of Life Assessment Survey (WHOQOL), and McMaster Family Assessment Device. Simultaneously, parents completed the Beck's Depression Inventory (BDI), Zarit Caregiver Burden Scale, World Health Organization Quality of Life Assessment Survey (WHOQOL), and McMaster Family Assessment Device. Dependent sample t-tests were used to evaluate within-group results before and after therapy. Changes over time in both groups were assessed using the Repeated Measures ANOVA method, with a focus on the group*time effect. Additionally, the Pearson correlation test was used to examine the relationship between continuous variables. Results: There was a statistically significant decrease in depressive symptoms and the severity of positive and negative symptoms in young individuals in both groups following Family Focused Therapy sessions. There was also a significant improvement in functionality among young individuals in both groups after the therapy, with a greater benefit observed in the bipolar disorder group. Moreover, young individuals demonstrated an increase in problem-focused and emotionally focused coping methods, along with a decrease in dysfunctional coping methods. Family-focused therapy sessions had a positive impact on parents as well, reducing their levels of emotional expression and criticality. Subsequently, significant changes were observed in the problem-solving, communication, and general functionality sub-domains among parents in the bipolar disorder group. Meanwhile, parents in the psychotic disorder group reported significant differences only in the behavioral control sub-domain. Collectively, young individuals diagnosed with psychotic disorders and the parents of those with bipolar disorders reported more benefits in various sub-domains from family-focused therapy sessions. Following family-focused therapy, parents in the bipolar disorder group experienced significant reductions in depressive symptoms and perceived caregiver burden, while parents in the psychotic disorder group saw a significant decrease in perceived caregiver burden, even though the decrease in depressive symptoms was not statistically significant. This highlights the importance of addressing parental mental health, which significantly contributes to the treatment process of young individuals. In particular, providing psychiatric support to parents of young individuals diagnosed with psychotic disorders and addressing parental depressive symptoms may positively impact treatment compliance and functionality. Conclusion: Our findings show that Family-Focused Therapy has positive effects on patients diagnosed with bipolar disorder and psychotic disorder, disease severity, quality of life and functionality, and family functionality. This study is important as this is the first pilot study co-evaluating the effects of Family-Focused Therapy on young individuals with recent-onset Bipolar Disorder and Psychotic Disorder.