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Intervening early in children with bipolar disorder: is there a pot at the end of the Rainbow?
  1. David J Miklowitz
  1. Division of Child and Adolescent Psychiatry, University of California, Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, California, USA;

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Setting the scene

Children with bipolar disorder (BD) have considerable impairments in school, peer and family functioning and high rates of illness comorbidity.1 With age, their risk increases for suicide attempts, hospitalisation, substance abuse and medical complications. Pharmacotherapy is usually the first-line treatment for young people with BD, but paediatric patients may be less treatment-responsive than adults.2 Moreover, side effects (eg, weight gain) from commonly used mood stabilising medications can compromise children's long-term health status. Three psychosocial interventions given adjunctively with medications have been tested and found effective in stabilising mood symptoms among bipolar children and adolescents: multifamily psychoeducation groups,3 dialectical behaviour therapy4 and family-focused therapy.5

Selected studies

In their study, West et al6 conducted a randomised controlled trial of a novel intervention called child and family-focused cognitive-behavioural therapy (CFF-CBT), a protocol summarised with the acronym ‘Rainbow’ (box 1) for children (ages 7–13) with bipolar disorder. Rainbow integrates individual CBT with family psychoeducation and mindfulness skills sessions. In a second article, using the same cohort as the West et al study, Weinstein et al7 examined baseline child, parent and family variables as potential moderators of response to CFF-CBT or a treatment-as-usual (TAU) comparison group.

Box 1

Elements of the RAINBOW Programme6,7

R=Routines (developing consistent daily habits)

A=Affect Regulation

I=I can do it! (improving self-esteem and self-efficacy)

N=No negative thoughts/live in the now

B=Be a good friend/balanced lifestyle

O=Oh, how do we solve this problem? (communication and problem-solving skills)

W=Ways to find support

The investigators recruited 69 participants (mean age 9.2 years, SD=1.6) with bipolar disorder (BD), not otherwise specified (BD-NOS; 62.3%), bipolar I disorder (31.9%) or bipolar II disorder (5.8%) for a randomised controlled trial. Children with BD-NOS usually have recurrent but short …

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