University of Pittsburgh researchers have begun a pilot study of a talk therapy they hope will lead to helping children at risk for inherited bipolar disorder avoid or at least delay the onset of the mental illness.

"It's a tall order, but I think we have some reasons to be hopeful. Even if we are only partially successful ... this would be a huge step forward," said Ellen Frank, leader of the research team, director of the Depression and Manic Depression Prevention Program at the Western Psychiatric Institute & Clinic of UPMC, and distinguished professor of psychiatry in Pitt's School of Medicine.

The study, funded by the Fine Foundation of Pittsburgh, involves families in which an adult with bipolar disorder is the parent of a child between the ages of 12 and 18 who does not have the illness characterized by mood swings.

Prior research has shown that the child of a bipolar parent has a likelihood of between 5 and 10 percent of developing the illness. That risk increases to about 15 percent if other relatives, such as a sibling or an aunt or uncle, also have it, and if both parents are bipolar, the child is at a 30 percent risk.

About nine or 10 families already are in the study and Dr. Frank said the team would like to enlist another 10 to 12 families. In the meantime, she said, "we are going to be applying to the National Institute of Mental Health for funding for a larger study that ultimately would have 100 or 150 family units. We're initially going to just do this work at Pitt, but eventually hope our colleagues around the country may join us in this enterprise."

The therapy being used in the study is called Interpersonal and Social Rhythm Therapy, and Dr. Frank said it has been shown to be effective in bipolar adults in two earlier studies.

"The basic premise is that new episodes of bipolar [activity] do not occur randomly, but actually occur as a result of either a disruption in one's regular routines or interpersonal or social role stress or a combination of the two, and often they go together," she said. For example, if someone loses his job, there is an "enormous disruption of routine" and bipolar sufferers seem to have very sensitive circadian rhythms, or 24-hour activity schedules. Examples of interpersonal or social role stress might be "a marital separation or divorce or a child going off to college. ...

"While people who don't have this vulnerability might be easily able to adjust to a big shift in routine, it seems bipolars have a difficult time in resetting their body clock ..." Dr. Frank added.

"People who have bipolar disorder or young people who are vulnerable to bipolar disorder might actually get stuck in space ... We have substantial evidence that substantial mania or depression are often preceded by life events that disrupt one's routines, and so we think these are major precipitants of major illness."

Conversely, Dr. Frank said, "We think if we can help people live lives more characterized by regularity we can prevent more episodes of depression and mania. The result of one study is that it seems to be true."

She said it is not yet known if teaching young people with the family-related risk for bipolar disorder to lead lives with regular routines will help prevent the onset of bipolar disorder.

The pilot study is designed to help them find out.

During the therapy, the research team uses two analogies in teaching the importance of regular routines. They point out that people without asthma can have deep carpeting, curtains, cats and parakeets but that people with asthma can't and that while people without diabetes can eat foods with starches and sugars, diabetics can't, Dr. Frank said.

"If you don't have bipolar disorder or if you're not in a family with bipolar disorder, you can get up at 7 a.m., noon, or 9 p.m., go to bed at all different hours, or eat at wildly different times ... but bipolars can't afford to do that; they've got to strengthen their body clock," she said.

"That's what we teach the young people and also how to do a better job of negotiating interpersonal or role challenges." Therapists might, for example, help a good student take on the additional challenge of a job or make the transition to going away from home to college.

"It's all talk therapy except in as much as we expect kids to work on regularizing their routines between sessions," Dr. Frank said. "We give them help in problem-solving and try to involve parents and explain why it might be important."

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