Weill Cornell Medicine, New York-Presbyterian Hospital, White Plains, New York.
Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York.
Int J Eat Disord. 2019 Jul;52(7):777-785. doi: 10.1002/eat.23088. Epub 2019 May 6.
Anorexia nervosa (AN) commonly develops during adolescence. Existing literature offers some treatment guidelines, but clear clinical criteria for initial recommendations and steps of care are needed. The aim of the present study was to develop expert consensus for a stepped-care algorithm for treatment of adolescents with AN.
The Delphi approach was used to identify clinical parameters that guide initial treatment recommendations and recommendations for transitions between levels of care. The Delphi approach provides a useful expert consensus when empirical data are limited. Individuals with at least 10 years of experience in the field of adolescent AN and membership in one of three professional organizations were recruited. Twenty-five panelists participated in three rounds of iterative online questionnaires.
Consensus was achieved on several features of a treatment algorithm. Hospitalization is recommended when medical instability, suicidality, or acute food refusal are present at any point in treatment. Family-based treatment (FBT) is recommended as the first-line treatment, with a few exceptions. Consensus was not reached on when to transition from a higher level of care to a lower level of care.
Expert opinion was used to develop a consensus-based algorithm for care of adolescents with AN. Future research is needed to test whether these recommendations can be used to optimize outcomes for adolescents with AN.
神经性厌食症（AN）通常在青少年时期发展。现有文献提供了一些治疗指南，但需要明确的临床标准来确定初始推荐和护理步骤。本研究旨在为治疗 AN 青少年的阶梯式护理算法制定专家共识。
采用德尔菲法确定指导初始治疗建议和护理水平之间过渡的临床参数。当经验数据有限时，德尔菲法提供了一种有用的专家共识。招募了至少在青少年 AN 领域有 10 年经验并属于三个专业组织之一的个人。25 名小组成员参加了三轮迭代在线问卷调查。
就治疗算法的几个特征达成了共识。当治疗过程中的任何时候出现医疗不稳定、自杀意念或急性食物拒绝时，建议住院治疗。家庭为基础的治疗（FBT）是一线治疗方法，但也有一些例外情况。对于何时从较高水平的护理过渡到较低水平的护理，尚未达成共识。
使用专家意见制定了基于共识的 AN 青少年护理算法。需要进一步研究以检验这些建议是否可以用于优化 AN 青少年的治疗结果。
