Cartwright Anna, Cheng Yat Ping, Schmidt Ulrike, Landau Sabine
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
Int J Eat Disord. 2017 Oct;50(10):1162-1171. doi: 10.1002/eat.22773. Epub 2017 Aug 26.
Sudden gains (SGs), broadly defined as sudden symptom reductions occurring between two consecutive treatment sessions, have been associated with improved treatment outcomes in anxiety and depression. The present study is the first to formally define SGs in anorexia nervosa and explore the characteristics, demographic and baseline clinical predictors, and clinical impact of SGs in anorexia nervosa.
This is a secondary analysis of data from 89 outpatients with broadly defined anorexia nervosa who received one of two psychotherapeutic interventions as part of the MOSAIC trial (Schmidt et al., 2015). SGs were defined using session-by-session body mass index (BMI) measures. This study investigated whether SGs were associated with changes in BMI, eating disorder symptomology, general psychopathology, and psychosocial impairment between baseline and 6, 12, and 24 months follow-up.
SGs, experienced by 61.8% of patients, mostly occurred during the early and middle phases of treatment. A larger proportion of SGs predicted larger increases in BMI between baseline and 6, 12, and 24 months follow-up. Amongst those experiencing at least one SG, fewer days between baseline and a patient's first SG predicted a larger increase in BMI between baseline and both 6 and 12 months follow-up. The proportion and timing of SGs did not predict changes in other outcome measures.
SGs in BMI during the outpatient treatment of anorexia nervosa are clinically useful predictors of longer-term weight outcomes.
突然改善（SGs），广义上定义为在连续两次治疗期间出现的症状突然减轻，已被证明与焦虑症和抑郁症治疗效果的改善有关。本研究首次正式定义神经性厌食症中的突然改善，并探讨其特征、人口统计学和基线临床预测因素，以及神经性厌食症中突然改善的临床影响。
这是对89名广义神经性厌食症门诊患者的数据进行的二次分析，这些患者接受了两种心理治疗干预中的一种，作为MOSAIC试验（施密特等人，2015年）的一部分。使用逐次测量的体重指数（BMI）来定义突然改善。本研究调查了突然改善是否与基线至6个月、12个月和24个月随访期间BMI、饮食失调症状、一般精神病理学和心理社会功能损害的变化有关。
61.8%的患者经历了突然改善，大多发生在治疗的早期和中期。在基线至6个月、12个月和24个月随访期间，较大比例的突然改善预示着BMI有更大的增加。在至少经历一次突然改善的患者中，从基线到患者首次突然改善的天数越少，预示着在基线至6个月和12个月随访期间BMI增加越大。突然改善的比例和时间并不能预测其他结局指标的变化。
神经性厌食症门诊治疗期间BMI的突然改善是长期体重结局的临床有用预测指标。
