CONCLUSION
ideation, manic, ’s mood swings, bipolar illness, mania, depressive, hypomania, depression
DISORDER
What have we learned about high-risk states in BD? First, working with families of high-risk youth on their understanding of the child’s mood swings and their ability to communicate and solve problems may be associated with a more favorable trajectory of mood symptoms and reductions in suicidal ideation and behavior. The effects of family intervention in the high-risk period appear to be more consistently focused on depression than on hypomania or mania, possibly reflecting the dominant polarity of symptoms early in the course of the disorder [FFT-HR appears to enhance neural circuits that underlie emotion regulation, such as activity in prefrontal and executive control regions critical for adaptive self-regulation, especially in the context of the significant and known family environmental disturbances associated with bipolar illness [We were unable to show that FFT-HR is effective in preventing the onset of syndromal BD I or II. Although FFT-HR had preventative effects on depressive episodes, the incidence of conversions to bipolar I or II, and more generally of new onset manic episodes, was relatively low (16%) over the short period of follow-up (average 2 years). Studies in which high-risk youth are followed over longer periods may demonstrate the preventative effects of family or other psychosocial interventions. Other approaches to early intervention that emphasize skill-building, such as dialectical behavior therapy [