Section of Eating Disorders, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK.
Br J Psychiatry. 2012 Nov;201(5):392-9. doi: 10.1192/bjp.bp.112.112078. Epub 2012 Sep 20.
Very limited evidence is available on how to treat adults with anorexia nervosa and treatment outcomes are poor. Novel treatment approaches are urgently needed.
To evaluate the efficacy and acceptability of a novel psychological therapy for anorexia nervosa (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) compared with specialist supportive clinical management (SSCM) in a randomised controlled trial.
Seventy-two adult out-patients with anorexia nervosa or eating disorder not otherwise specified were recruited from a specialist eating disorder service in the UK. Participants were randomly allocated to 20 once weekly sessions of MANTRA or SSCM and optional additional sessions depending on severity and clinical need (trial registration: ISRCTN62920529). The primary outcomes were body mass index, weight and global score on the Eating Disorders Examination at end of treatment (6 months) and follow-up (12 months). Secondary outcomes included: depression, anxiety and clinical impairment; neuropsychological outcomes; recovery rates; and additional service utilisation.
At baseline, patients randomised to MANTRA were significantly less likely to be in a partner relationship than those receiving SSCM (3/34 v. 10/36; P<0.05). Patients in both treatments improved significantly in terms of eating disorder and other outcomes, with no differences between groups. Strictly defined recovery rates were low. However, MANTRA patients were significantly more likely to require additional in-patient or day-care treatment than those receiving SSCM (7/34 v. 0/37; P = 0.004).
Adults with anorexia nervosa are a difficult to treat group. The imbalance between groups in partner relationships may explain differences in service utilisation favouring SSCM. This study confirms SSCM as a useful treatment for out-patients with anorexia nervosa. The novel treatment, MANTRA, designed for this patient group may need adaptations to fully exploit its potential.
目前关于如何治疗成人厌食症以及治疗效果较差的证据非常有限。迫切需要新的治疗方法。
在一项随机对照试验中，评估一种新型心理治疗厌食症（Maudsley 成人厌食症治疗模式，MANTRA）与专科支持性临床管理（SSCM）相比的疗效和可接受性。
从英国一家专科饮食失调服务机构招募了 72 名患有厌食症或未特指饮食障碍的成年门诊患者。参与者被随机分配到每周一次的 MANTRA 或 SSCM 20 次，根据严重程度和临床需要可选择额外的疗程（试验注册：ISRCTN62920529）。主要结局是治疗结束时（6 个月）和随访时（12 个月）的体重指数、体重和饮食障碍检查的总体评分。次要结局包括：抑郁、焦虑和临床损伤；神经心理学结局；恢复率；以及额外的服务利用情况。
在基线时，与接受 SSCM 的患者相比，接受 MANTRA 的患者处于伴侣关系的可能性明显较低（3/34 与 10/36；P<0.05）。接受两种治疗的患者在饮食障碍和其他结局方面均有显著改善，两组间无差异。严格定义的恢复率较低。然而，与接受 SSCM 的患者相比，接受 MANTRA 的患者更有可能需要额外的住院或日间治疗（7/34 与 0/37；P=0.004）。
厌食症成年患者是一组难以治疗的人群。在伴侣关系方面，两组之间的不平衡可能解释了有利于 SSCM 的服务利用差异。本研究证实 SSCM 是一种有效的门诊厌食症治疗方法。针对该患者群体设计的新型治疗方法 MANTRA 可能需要进行调整，以充分发挥其潜力。
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