Foulon C, Guelfi J D, Kipman A, Adès J, Romo L, Houdeyer K, Marquez S, Mouren M C, Rouillon F, Gorwood P
CMME-Sainte Anne, Psychiatric Department of the University Hospitals, 100 rue la Santé, 75674 Paris Cedex 14, France.
Eur Psychiatry. 2007 Nov;22(8):513-9. doi: 10.1016/j.eurpsy.2007.03.004. Epub 2007 May 7.
Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap.
Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable.
Major depressive disorder (p<0.001) and subtype switch from the restrictive to the bingeing/purging type (p<0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR=15) when compared to patients with neither major depressive disorder nor bingeing/purging type.
Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.
神经性厌食症在精神疾病中具有最高的自杀死亡率，自杀与多种因素相关。我们考虑到这些因素可能存在的重叠情况，评估了这些因素首次在一生中出现的情况。
1999年12月至2003年1月期间，在巴黎郊区的三家医院系统招募了304名神经性厌食症（DSM-IV）的住院和门诊患者。通过面对面访谈（DIGS）对患者进行评估。测量当前的饮食失调维度，由经过培训的临床医生对患者进行访谈，以评估最低体重指数，并回顾性地评估神经性厌食症、重度抑郁症、焦虑症首次出现的年龄，以及是否适用从限制型转变为暴饮暴食/清除型的情况。
重度抑郁症（p<0.001）和从限制型转变为暴饮暴食/清除型的亚型（p<0.001）是在自杀未遂前显著更频繁出现的两个因素，并且在进行多变量分析时仍然相关，无论使用的是综合征测量还是维度测量。通过生存分析考虑一生中的发生情况，神经性厌食症转变为暴饮暴食/清除型似乎是一个主要的预测因素，与既没有重度抑郁症也没有暴饮暴食/清除型的患者相比，自杀未遂的频率大幅增加（OR = 15）。
神经性厌食症的暴饮暴食/清除型与自杀未遂密切相关，可能值得特别关注。如果在前瞻性设计的研究中得到证实，这些结果将支持对暴饮暴食和清除行为的这一方面进行早期检测和/或更强化、更具体的治疗干预。
