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治疗前患者特征对青少年和成年神经性厌食症个体和家庭治疗中脱落和治疗效果的预测作用:系统评价和荟萃分析。

Pre-treatment patient characteristics as predictors of drop-out and treatment outcome in individual and family therapy for adolescents and adults with anorexia nervosa: A systematic review and meta-analysis.

机构信息

Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.

Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.

出版信息

Psychiatry Res. 2019 Jan;271:484-501. doi: 10.1016/j.psychres.2018.11.068. Epub 2018 Dec 2.

Abstract

Understanding variables predicting drop-out or unfavourable outcome following treatment for anorexia nervosa (AN) may help to improve upon intervention efforts. However, the current literature has demonstrated sparse and inconsistent significant findings. The current systematic review and meta-analysis summarised the evidence base examining baseline predictors of drop-out and outcome in AN treatment. A literature search was conducted to identify research investigating predictors of drop-out and outcome in individuals treated for AN. Four online databases were searched, and predictors were organised by category and dependent variable (outcome versus drop-out). 27 studies were included. Lower motivation, lower BMI, and having the binge-purge subtype of AN predicted drop-out. Greater ED pathology and poorer motivation predicted poorer outcome. Clinical recommendations include taking particular care during assessment stages to identify patients at risk of drop-out and/or poor outcome based on their clinical profile and level of motivation for recovery. At-risk patients should be receiving tailored treatment to enhance engagement and reduce risk of drop-out. In conclusion, there's some evidence that motivation, BMI, subtype, and ED pathology predicts drop-out and/or outcome in individual and family-based therapy for AN amongst adolescents and adults; however, research incorporating carefully designed multi-site studies is required to further examine these findings.

摘要

了解预测厌食症 (AN) 治疗后辍学或不良结果的变量可能有助于改进干预措施。然而,目前的文献表明,有意义的发现很少且不一致。本系统评价和荟萃分析总结了考察 AN 治疗中辍学和结果的基线预测因子的证据基础。进行了文献检索,以确定研究厌食症治疗个体辍学和结果预测因子的研究。搜索了四个在线数据库,并按类别和因变量(结果与辍学)组织预测因子。共纳入 27 项研究。较低的动机、较低的 BMI 和具有暴食-清除型 AN 预测辍学。更高的 ED 病理和较差的动机预测较差的结果。临床建议包括在评估阶段特别注意,根据患者的临床特征和康复动机水平,识别有辍学和/或不良结果风险的患者。有风险的患者应接受个性化治疗,以提高参与度并降低辍学风险。总之,有一些证据表明,在青少年和成年人的个体和家庭治疗中,动机、BMI、亚型和 ED 病理预测厌食症的辍学和/或结果;然而,需要进行精心设计的多地点研究来进一步检验这些发现。

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