预测初级保健中暴饮暴食症药物治疗和自助治疗的有意义结果：早期快速反应的重要性。
Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response.
作者信息
Grilo Carlos M, White Marney A, Masheb Robin M, Gueorguieva Ralitza
机构信息
Department of Psychiatry, Yale University School of Medicine.
Department of Biostatistics, Yale University School of Public Health.
出版信息
J Consult Clin Psychol. 2015 Apr;83(2):387-94. doi: 10.1037/a0038635. Epub 2015 Jan 26.
OBJECTIVE
We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing antiobesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings.
METHOD
One hundred four obese patients with BED were randomly assigned to 1 of 4 treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research clinicians monthly throughout treatment, posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge eating by the fourth treatment week, was used to predict outcomes.
RESULTS
Rapid response characterized 47% of patients, was unrelated to demographic and baseline clinical characteristics, and was significantly associated, prospectively, with remission from binge eating at posttreatment (51% vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs. 23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was significantly associated with greater decreases in binge-eating or eating-disorder psychopathology, depression, and percent weight loss.
DISCUSSION
Our findings, based on a diverse obese patient group receiving medication and shCBT for BED in primary-care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatment. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes, even in low-intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED.
CLINICAL TRIAL REGISTRATION
clinicaltrials.gov: NCT00537810 (PsycINFO Database Record
目的
在一项随机临床试验中，我们对初级保健机构中接受抗肥胖药物和自助认知行为疗法（shCBT）单独及联合治疗的暴饮暴食症（BED）肥胖患者的快速反应进行了研究。
方法
104名患有BED的肥胖患者被随机分配到4种治疗方法中的一种：西布曲明、安慰剂、shCBT + 西布曲明或shCBT + 安慰剂。治疗由普通初级保健医生提供，药物采用双盲给药。在整个治疗过程、治疗后（4个月）以及6个月和12个月随访（即随机分组后16个月）期间，由经过培训和监督的博士研究生临床医生每月进行独立评估。快速反应定义为在治疗第四周暴饮暴食减少≥65%，用于预测治疗结果。
结果
47%的患者具有快速反应，这与人口统计学和基线临床特征无关，并且前瞻性地与治疗后（快速反应者为51%，非快速反应者为9%）、6个月（53%对23.6%）和12个月（46.9%对23.6%）随访时暴饮暴食的缓解显著相关。混合效应模型分析显示，快速反应与暴饮暴食或饮食失调精神病理学、抑郁以及体重减轻百分比的更大降幅显著相关。
讨论
我们的研究结果基于在初级保健机构中接受药物和shCBT治疗BED的多样化肥胖患者群体，表明快速反应的患者在治疗结束后的12个月随访中取得了良好的临床结果。快速反应代表了具有临床意义结果的强有力预后指标，即使在低强度药物和自助干预中也是如此。快速反应对BED的阶梯式护理治疗模式具有重要的临床意义。
临床试验注册
clinicaltrials.gov：NCT00537810（PsycINFO数据库记录）
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