Fichter M M, Quadflieg N
Department of Psychiatry, University of Munich, Munich, Germany.
Int J Eat Disord. 1999 Dec;26(4):359-85. doi: 10.1002/(sici)1098-108x(199912)26:4<359::aid-eat2>3.0.co;2-7.
Since there are discrepant findings in the literature, we studied the longer-term course in a large sample of 103 DSM-IV anorexia nervosa (AN) patients.
Assessments were made at four points of time: beginning of therapy, end of therapy, 2-year follow-up, and 6-year follow-up. Self-rating scales as well as expert-rating interview data were used. Eating disorder-specific and general psychopathology were assessed. These data were also compared with data on the 6-year course of patients with bulimia nervosa and binge eating disorder, respectively, who were treated at the same institution at about the same time.
The participation rate at the two follow-ups was high (97.9% of those alive). The general pattern of results over time of those alive at 6-year follow-up was as follows: substantial improvement during therapy, moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 6 years posttreatment. At the time of the 6-year follow-up, 26.8% had AN, 9. 9% had bulimia nervosa-purging type (BN-P), 2.0% were classified as eating disorder not otherwise specified (ED-NOS), all diagnosed according to DSM-IV criteria; more than one half (55.4%) showed no major DSM-IV eating disorder. Based on an operationalized global outcome score at 6-year follow-up, 34.7% had a good outcome, 38.6% an intermediate outcome, 20.8% a poor outcome, and 6 of 101 persons (5.9%) were deceased. Body mass index was 17.9 +/- 2.8 at the 6-year follow-up; amenorrhea was still found in 23.9%.
In comparison to samples with bulimia nervosa or binge eating disorder, the 6-year course of anorexia nervosa was less favorable. Mortality was rather high and symptomatic recovery protracted; predictors of unfavorable 6-year course were the presence of binges during 4 weeks before index treatment, psychiatric comorbidity, and low body weight at discharge from index treatment.
鉴于文献中有不一致的研究结果，我们对103例符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的神经性厌食症（AN）患者的大样本进行了长期病程研究。
在四个时间点进行评估：治疗开始时、治疗结束时、2年随访和6年随访。使用自评量表以及专家评定访谈数据。评估了饮食失调特异性和一般性精神病理学情况。这些数据还分别与大约同一时间在同一机构接受治疗的神经性贪食症和暴饮暴食症患者6年病程的数据进行了比较。
两次随访的参与率很高（在世者的97.9%）。6年随访时在世者随时间变化的总体结果模式如下：治疗期间有显著改善，治疗后前2年有中度（在许多情况下无显著意义）下降，治疗后3至6年有进一步改善。在6年随访时，26.8%的患者患有AN，9.9%的患者患有神经性贪食症清除型（BN-P），2.0%被归类为未另行规定的饮食失调（ED-NOS），所有诊断均根据DSM-IV标准；超过一半（55.4%）的患者未出现主要的DSM-IV饮食失调。根据6年随访时的操作性总体结果评分，34.7%的患者预后良好，38.6%的患者预后中等，20.8%的患者预后不良，101人中有6人（5.9%）死亡。6年随访时体重指数为17.9±2.8；仍有23.9%的患者闭经。
与神经性贪食症或暴饮暴食症样本相比，神经性厌食症的6年病程不太乐观。死亡率相当高，症状恢复迁延；6年病程不佳的预测因素是索引治疗前4周内出现暴饮暴食、精神共病以及索引治疗出院时体重过低。
