Department of Paediatrics, University of Melbourne, Melbourne, Australia.
Murdoch Children's Research Institute, Parkville, Australia.
Int J Eat Disord. 2017 Apr;50(4):424-432. doi: 10.1002/eat.22662. Epub 2017 Jan 17.
The aim of this case series was to examine engagement in and outcomes of family-based treatment (FBT) for adolescents with DSM-5 atypical AN, that is, adolescents who were not underweight at presentation. Consecutive referrals for FBT of adolescents with atypical AN to a specialist child and adolescent eating disorder program were examined. Engagement in treatment (i.e., dose of treatment, completion rate), and changes in psychological symptomatology (i.e., eating disorder symptoms, depressive symptoms, self-esteem, obsessive compulsiveness), weight, and menstrual function were examined. The need for additional interventions (i.e., hospitalization and medication), and estimated remission rates were also examined. The sample comprised 42 adolescents aged 12-18 years (88% female). Engagement in FBT was high, with 83% completing at least half the treatment dose. There were significant decreases in eating disorder and depressive symptoms during FBT (p < .05) but no improvement in self-esteem. There was no significant change in percent of median BMI for age and gender for the sample as a whole (105 vs. 106%, p = .128). However, adolescents who were not admitted to hospital prior to FBT gained some weight (M = 3.4 kg) while those who were admitted did not gain weight during FBT (M = 0.2 kg, p < .01). The overall remission rate ranged from 38 to 52% depending on the criteria applied. FBT appears to be an effective treatment for adolescents with atypical AN. However, more research is needed into systematic adaptations of FBT and other treatments that could improve overall remission rates.
本病例系列研究旨在探讨针对 DSM-5 非典型神经性厌食症（即就诊时未体重不足的青少年）患者的家庭为基础的治疗（FBT）的参与度和治疗结果。我们对一个专门的儿童和青少年饮食障碍项目中接受 FBT 治疗的非典型 AN 青少年的连续转诊情况进行了研究。评估了治疗的参与度（即治疗剂量、完成率）、心理症状（即饮食障碍症状、抑郁症状、自尊、强迫观念）、体重和月经功能的变化。还评估了是否需要额外干预（即住院和药物治疗）以及估计的缓解率。样本包括 42 名年龄在 12-18 岁之间的青少年（88%为女性）。FBT 的参与度很高，83%的患者至少完成了一半的治疗剂量。在 FBT 过程中，饮食障碍和抑郁症状显著减轻（p<.05），但自尊没有改善。整个样本的体重指数中位数百分比没有显著变化（105%对 106%，p=.128）。然而，在接受 FBT 治疗前未住院的青少年体重有所增加（M=3.4 公斤），而住院的青少年在 FBT 期间体重没有增加（M=0.2 公斤，p<.01）。根据应用的标准，总体缓解率在 38%至 52%之间。FBT 似乎是治疗非典型 AN 青少年的有效方法。然而，需要更多的研究来系统地调整 FBT 和其他治疗方法，以提高总体缓解率。
