Beumont Pierre, Hay Phillipa, Beumont Daphne, Birmingham Laird, Derham Harry, Jordan Amanda, Kohn Michael, McDermott Brett, Marks Peta, Mitchell Jim, Paxton Susan, Surgenor Lois, Thornton Chris, Wakefield Alison, Weigall Sue
School of Medicine, James Cook University, Townsville, Queensland 4811, Australia.
Aust N Z J Psychiatry. 2004 Sep;38(9):659-70. doi: 10.1080/j.1440-1614.2004.01449.x.
The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health. This CPG covers anorexia nervosa (AN).
The CGP team consulted with scientists, clinicians, carers and consumer groups in meetings of over 200 participants and conducted a systematic review of meta-analyses, randomized controlled trials and other studies.
It is extremely difficult to draw general conclusions about the efficacy of specific treatment options for AN. There are few controlled clinical trials and their quality is generally poor. These guidelines necessarily rely largely upon expert opinion and uncontrolled trials. A multidimensional approach is recommended. Medical manifestations of the illness need to be addressed and any physical harm halted and reversed. Weight restoration is essential in treatment, but insufficient evidence is available for any single approach. A lenient approach is likely to be more acceptable to patients than a punitive one and less likely to impair self-esteem. Dealing with the psychiatric problems is not simple and much controversy remains. For patients with less severe AN who do not require in-patient treatment, out-patient or day-patient treatment may be suitable, but this decision will depend on availability of such services. Family therapy is a valuable part of treatment, particularly for children and adolescents, but no particular approach emerges as superior to any other. Dietary advice should be included in all treatment programs. Cognitive behaviour therapy or other psychotherapies are likely to be helpful. Antidepressants have a role in patients with depressive symptoms and olanzapine may be useful in attenuating hyperactivity.
澳大利亚和新西兰皇家精神科医学院正在协调制定精神病学临床实践指南（CPG），该指南由澳大利亚国家心理健康战略和新西兰卫生部资助。本CPG涵盖神经性厌食症（AN）。
CPG团队在200多名参与者参加的会议上咨询了科学家、临床医生、护理人员和消费者团体，并对荟萃分析、随机对照试验和其他研究进行了系统综述。
很难就AN特定治疗方案的疗效得出一般性结论。对照临床试验很少，而且其质量普遍较差。这些指南必然很大程度上依赖专家意见和非对照试验。建议采用多维度方法。需要解决该疾病的医学表现，阻止并扭转任何身体伤害。体重恢复在治疗中至关重要，但对于任何单一方法都缺乏足够证据。宽松的方法可能比惩罚性方法更容易被患者接受，且不太可能损害自尊。处理精神问题并不简单，争议仍然很大。对于不需要住院治疗的病情较轻的AN患者，门诊或日间住院治疗可能合适，但这一决定将取决于此类服务的可获得性。家庭治疗是治疗的重要组成部分，尤其是对儿童和青少年，但没有哪种特定方法明显优于其他方法。所有治疗方案都应包括饮食建议。认知行为疗法或其他心理疗法可能会有帮助。抗抑郁药对有抑郁症状的患者有作用，奥氮平可能有助于减轻多动症状。
