School of Medicine, University of Western Sydney, Penrith, Australia.
Aust N Z J Psychiatry. 2012 Dec;46(12):1136-44. doi: 10.1177/0004867412450469. Epub 2012 Jun 13.
Many patients with anorexia nervosa develop an intractable and debilitating illness course. Our aims were to (i) conduct a systematic review of randomised controlled trials (RCTs) of treatment for chronic anorexia nervosa participants, and (ii) identify research informing novel therapeutic approaches for this group.
Systematic search (SCOPUS plus previous reviews date 2011) of literature for (i) RCTs of treatment that included anorexia nervosa participants with a mean duration of illness of at least 3 years, (ii) studies reporting new treatments addressing factors associated with chronicity.
Evidence of efficacy for treatment approaches in severe and enduring anorexia nervosa is limited. Only one unpublished RCT designed to test a specific psychological approach for these patients was identified. There is a probable advantage for specialist psychotherapy over treatment as usual, and a promising study of relapse prevention with cognitive behaviour therapy (CBT) for anorexia nervosa (CBT-AN). Open trials have, however, reported developments in psychological therapies that warrant further specific evaluation. These include forms of CBT modified for anorexia nervosa, cognitive remediation therapy with emotion skills training, the Maudsley Model for Treatment of Adults with Anorexia Nervosa, the Community Outreach Partnership Program, Specialist Supportive Clinical Management and the approach of Strober with its emphasis on therapeutic alliance and flexible goals.
Treatment trials need to move beyond targeting core eating disorder pathology (primarily weight restoration) and examine efficacy and effectiveness in minimising harm and reducing personal and social costs of chronic illness. There is also a need to develop better definitions of chronicity, with or without treatment 'resistance' specifiers.
许多神经性厌食症患者会出现难以治愈且虚弱的病程。我们的目的是：(i) 对慢性神经性厌食症患者治疗的随机对照试验（RCT）进行系统回顾，(ii) 确定为该人群提供新治疗方法的研究。
对文献进行系统搜索（SCOPUS 加 2011 年之前的综述），以寻找 (i) 包括平均患病时间至少 3 年的神经性厌食症患者的治疗 RCT，(ii) 报告针对与慢性相关因素的新治疗方法的研究。
针对严重和持久的神经性厌食症治疗方法的证据有限。仅确定了一项针对这些患者的特定心理方法的未发表 RCT。专科心理治疗比常规治疗可能有优势，并且针对神经性厌食症认知行为治疗（CBT）的预防复发研究也很有前景（CBT-AN）。然而，开放性试验报告了心理治疗的发展，这些发展值得进一步进行特定评估。其中包括为神经性厌食症修改的 CBT 形式、具有情绪技能训练的认知矫正治疗、Maudsley 成人神经性厌食症治疗模型、社区外联伙伴计划、专科支持性临床管理以及 Strober 的方法，其重点是治疗联盟和灵活的目标。
治疗试验需要超越针对核心饮食障碍病理学（主要是体重恢复）的目标，并检查在减轻伤害和减少慢性疾病的个人和社会成本方面的疗效和有效性。还需要制定更好的慢性定义，无论是否有治疗“抵抗”的具体说明。
