Challenges With Treatment Engagement, Retention for Youth at Risk for Bipolar Disorder

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Researchers identified youth at genetic risk for bipolar disorder and provided a psychosocial intervention to delay or prevent the onset of bipolar disorder.

Adolescents who are at risk for bipolar disorder present challenges to psychosocial treatment engagement and retention, according to results published in the Journal of Affective Disorders.

It is unclear whether interpersonal and social rhythm therapy (IPSRT) is effective for this population because of low treatment adherence. Studies with larger samples and extended follow-up may be able to determine whether IPSRT may be beneficial for at-risk youth.

The study included participants aged 12 to 18 years who had a parent with bipolar disorder (n=42). Each participant was randomly assigned to undergo IPSRT plus data-informed referral (DIR) or DIR alone. 

Outcomes were assessed at baseline and at 3 and 6 months. “Participants wore an actigraph to measure sleep/wake patterns for 7 days at baseline and at 6-months. Primary outcomes included mood and non-mood symptoms and sleep disturbance,” the authors wrote.

The participants assigned to IPSRT+DIR “attended approximately half of the scheduled IPSRT appointments.”

Whereas a third of DIR-only participants were referred to mental services at intake, none initiated new services during the follow-up period.

None of the participants developed new-onset mood disorders during the follow-up period.

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One participant in the IPSRT+DIR group displayed subthreshold hypo/manic symptoms compared with 2 participants in the DIR-only group (odds ratio, 14.7; P= .03).

“IPSRT merits further study as an acceptable intervention for at-risk youth, though necessary frequency and intensity to affect outcomes should be examined,” the researchers wrote.


Goldstein TR, Merranko J, Krantz M, et al. Early intervention for adolescents at-risk for bipolar disorder: a pilot randomized trial of interpersonal and social rhythm therapy (IPSRT) [published online April 6, 2018]. J Affect Disord. doi: 10.1016/j.jad.2018.04.049