Wilson G T, Vitousek K M, Loeb K L
Eating Disorders Clinic, Rutgers, State University of New Jersey, University College-Piscataway 08854, USA.
J Consult Clin Psychol. 2000 Aug;68(4):564-72.
A stepped care approach would link different patient needs to therapeutic modalities that range from simple advice to intensive inpatient care. Brief methods, including self-help and psychoeducation, may be effective for a subset of patients with bulimia nervosa and binge eating disorder. Identifying this subset remains a challenge. It is unclear how patients who fail to respond to evidence-based, first-line treatments should be treated. Given the absence of data on effective treatment of anorexia nervosa (AN), discussion of a stepped care approach is speculative. Because AN typically demands expert and sustained treatment, the lower levels of stepped care models are inapplicable for these patients. A stepped care approach poses methodological challenges for clinical research and raises important clinical issues, such as when to switch from 1 level of treatment to another.
一种逐步护理方法会将不同的患者需求与从简单建议到强化住院护理等一系列治疗方式联系起来。包括自助和心理教育在内的简短方法，可能对神经性贪食症和暴饮暴食症的一部分患者有效。确定这一亚组患者仍然是一项挑战。对于那些对循证一线治疗无反应的患者应如何治疗尚不清楚。鉴于缺乏关于神经性厌食症（AN）有效治疗的数据，对逐步护理方法的讨论具有推测性。由于神经性厌食症通常需要专业且持续的治疗，逐步护理模式的较低级别不适用于这些患者。逐步护理方法给临床研究带来了方法学挑战，并引发了重要的临床问题，比如何时从一个治疗级别转换到另一个级别。
