How does bipolar disorder present differently in youth than adults?
- Brief but clear mood episodes - several hours to days
- Chronic mood lability, affective storms
- Poor recovery between episodes
- Rapid cycling, mixed symptoms, mild psychosis
- Chronic or relapsing course, with high rates of
- –Mixed episodes or psychosis (⅓)
- –Suicide attempts (⅓ - ½ )
- –Comorbid psychiatric illnesses (60% - 90%)
- –Hospitalization and functional impairment
- —Nonadherence to medications
Give one example of each of the 3 elements of Expressed Emotion (EE), and explain how EE is related to patient outcome in bipolar and other disorders.
- Hostility
- Criticism
- Emotional Over- involvement
What are the 4 elements of FFT, and what does each element focus on?
Psychoeducation
Communication Enhancement Training
Problem solving skills training
Psychoeducation
7+ sessions covering
- Sings and symptoms of the disorder
- The vulnerability/ stress model
- Identifying perciptitating life events
- Encouraging medication adherence
- Keeping the family environment low key
- Developing a relapse prevention
Communication Enhancement Training
7- 10 sessions of communication enhancement training, in which role-playing exercises focus on:
- Expressing positive feelings
—Look at the person
—Say exactly what they did that pleased you
—Tell him or her how that made you feel
- Active listening
- Making positive requests for change in others’ behaviors
—Look at the person
—Say exactly what you would like him or her to do
—Tell him or her how it would make you feel
In making positive requests use phrases like
“I would like you to…” etc
—-Expressing negative feelings (about specific behaviors)
Look at the person; speak firmly
Say exactly what he or she did that you did not like
Tell him or her how you felt when they did that
Suggest how the person might prevent this from happening in the future
Problem solving skills
4-5 sessions of problem solving skills training, usually covering conflicts related to:
- Medication nonadherence
- Resuming social, occupational, or school functioning
- Relationship and living situation conflicts
“Life trashing”
What are mood charts, and how might they be helpful to adolescent individuals with bipolar disorder and their families?
Mood charts reflect what the mood is when you do a specific activity and helps to create a starting point when finding the source of a families’ stress
How does communication training happen in FFT sessions? Give an example of how communication training might help a family who has an adolescent child with bipolar disorder.
- Model the skill for the partiicpants (active listening)
- Ask family members to turn chairs toward each other
- Ask one member to rehearse the skill with anohter
- Offer praise for his/her attempts
- Encourage constructive feedback from other family members
- Summarize feedback and encourage him/her to practice again
- Assign hw to entire family
What are the steps of problem solving within FFT?
- Agree on the problem
- Suggest several possible solutions (brainstorm)
- Discuss pros and cons agree on best solutions
- Plan and carry out best solution
- Praise efforts; review effectiveness
