By Moryt Milo
When Dr. Manpreet Singh, associate professor of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, talks about the future for those with bipolar disorder, she is optimistic that early intervention and prevention can change the outcome for at-risk youth.
Evidence from her clinical studies shows that family-focused psychotherapy can reduce the number of mood-disorder relapses if addressed during early childhood in families with a history of bipolar disorder.
“We do know that medicine and psychotherapy have a lifelong effect. Now we know that early intervention and prevention as well as timely treatment can be a major source of hope to episode prevention,” said Dr. Singh, who is trained in Pediatrics, Psychiatry, and Child and Adolescent Psychiatry.
Bipolar disorder is a complex, serious mental illness—a mood disorder with energy levels that swing between mania and depression. Both can be severe, and depression can lead to suicide ideation.
Factors such as environmental stress, genetics, brain inflammation all come into play. Through her work, Dr. Singh has discovered that the brain is “very susceptible to the environment.” This includes relationships in families.
In families with bipolar disorder history, where the environment is chaotic and parents are judgmental, hostile or overly involved, the child is likely to be diagnosed with bipolar 1 or 2, the doctor said. “This clearly seems to have a role in brain function and development,” Dr. Singh said.
Recognizing this correlation, the doctor developed a model targeted at early intervention before the onset of symptoms. She identified that bipolar disorder can be triggered by family trauma and struggles with resilience, and focused her work on resilience and the ability to adapt successfully to adversity, threats, and trauma. Her research explored the cultivation of prosocial behaviors, where parents and children live in a more collaborative environment—defined as Family-Focused Therapy.
A four-year clinical study with 150 youth points to neurocircuits that are particularly involved in emotion regulation. The work has shown that with early Family-Focused Therapy and prosocial behaviors, those most suspectable can be put on the right path, she said.
“We learned there are aspects of the brains of children of parents with bipolar disorder that are very resilient and can compensate in many ways,” she said.
Education and management of symptoms, plus training in prosocial behavior that includes activities in listening and families working collaboratively make a significant difference in the frequency of relapse periods for at-risk youth.
The study compared the vulnerable children to the same children with no family history of bipolar disorder or symptoms and saw a strengthening in the brain, said Dr. Singh. The result was an improvement in depression through family-focused therapy.
“We think that this therapy is very specific and we have figured out a way to change the brain and the outcome, said Dr Singh, who is also the Director of the Pediatric Mood Disorders Program and Director of the Pediatric Emotion and Resilience Lab.
The doctor pointed out that function recovery and quality of life are much more important than just symptomatic recovery which is keyed to relapses instead of long-term stability.
“The most fascinating discovery in my view is the concept that family-focused therapy is making an improvement on the environment actually changes the brain,” Dr. Singh said,
Like other severe mental illness, there is no one size fits all. Some individuals need a different approach to recovery. That may come in the form of mindfulness, behavioral cognitive therapy, or interpersonal social rhythm therapy. Yet to date, family-focused therapy has produced the strongest level of evidence for at-risk youth with a family history of bipolar disorder.
It is Dr. Singh’s goal to discover a way to “activate the brain to protect itself kind of like a vaccine or medication,” she said.
To view Dr. Manpreet Singh’s general meeting presentation on YouTube, click on the video below