Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York.
Weill Cornell Medical Center, Presbyterian Hospital, White Plains, New York.
Int J Eat Disord. 2020 Jul;53(7):1088-1096. doi: 10.1002/eat.23237. Epub 2020 Feb 7.
Psychiatric illnesses, like medical illnesses, can sometimes be considered as progressing through stages. Understanding these stages can lead to a better understanding of pathophysiology, and clarification of prognosis and treatment needs. Opinions from experts in the field of anorexia nervosa (AN) were sought to create a model of stages of illness.
The Delphi approach was used to achieve consensus from a panel of 31 individuals from a range of disciplines with expertise in AN. Over three iterative rounds, participants rated agreement with statements about an overall staging framework and definitions of specific stages.
Agreement was reached about a longitudinal progression including Subsyndromal, Full Syndrome, Persistent Illness, and Partial and Full Remission. The panel achieved consensus in defining Subsyndromal AN as characterized by body image disturbance and mild to moderate restrictive eating. Overall, there was consensus that restrictive eating is central to the behavioral features of all stages of AN, and agreement that its absence is essential to any stage of health. There was little consensus about biological markers, other than body mass index, and no consensus about quality of life indices associated with different stages.
This panel discussion yielded an expert-informed staging model for AN. This model now needs to be tested for its validity. The lack of consensus in several areas highlighted other research questions to address in order to develop an empirically valid and scientifically useful model of the progression of AN.
与医学疾病一样，精神疾病有时也可以被认为是分阶段发展的。了解这些阶段可以帮助我们更好地理解病理生理学，并阐明预后和治疗需求。本研究旨在寻求厌食症（AN）领域专家的意见，以建立疾病阶段模型。
采用德尔菲法，从多个学科领域的 31 名专家中获得共识。在三轮迭代中，参与者对总体分期框架和特定阶段定义的陈述表示同意的程度进行了评分。
达成了关于纵向进展的共识，包括亚综合征、全综合征、持续疾病、部分和完全缓解。专家组就亚综合征 AN 的定义达成了共识，其特征为身体意象障碍和轻度至中度限制进食。总体而言，专家组一致认为限制进食是 AN 所有阶段行为特征的核心，并且一致认为健康任何阶段都必须没有限制进食。除了体重指数外，专家组对生物标志物几乎没有达成共识，对与不同阶段相关的生活质量指数也没有达成共识。
本次小组讨论得出了一个基于专家意见的 AN 分期模型。该模型现在需要进行验证。在几个领域缺乏共识突出了其他需要解决的研究问题，以便开发一个具有 AN 进展的经验有效性和科学有用性的模型。
