Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA.
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Int J Eat Disord. 2020 Aug;53(8):1337-1348. doi: 10.1002/eat.23246. Epub 2020 Feb 17.
We explored the utility of "staging" anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12-month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment.
We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: "early stage" (illness duration <3 years; n = 60) and "severe and enduring" stage (SE-AN; n = 41) indicated by distress (Depression Anxiety and Stress Scales, DASS ≥60) and illness duration (≥7 years).
At 12 months, patients reported large improvements in body mass index, small to moderate improvements in ED symptoms, mood, and work/social adjustment, and 23.6% met criteria for recovery. However, patients classified as SE-AN reported higher rates of accessing intensive services, higher ED symptomatology, and poorer work/social adjustment at baseline, and lower rates of improvement in work/social adjustment at 12 months compared to "early stage" respondents.
Although present findings suggest overall symptomatic improvements, exploratory results highlight marked differences in course and service use between people at different stages of AN, suggesting a need to consider staging for clinical decision-making. Further research differentiating between clinical subtypes of AN and adoption of a more personalized approach may ensure that services and care pathways better fit patient needs.
我们通过疾病持续时间和心理健康状况探索了将厌食症 (AN)“分期”的效用。我们还调查了在对接受门诊治疗的大量 AN 患者进行评估的多地点临床研究中，12 个月的症状轨迹和服务使用情况。
我们对来自英格兰 NHS 22 家专门饮食失调 (ED) 服务机构的成人 AN 患者(n=187)进行了一项数字治疗增强研究的多站点临床试验的二次分析。在干预后(postintervention)（六周）、6 个月和 12 个月时测量临床结果和服务使用情况。我们将患者分为两类：“早期阶段”（疾病持续时间<3 年；n=60）和“严重和持久阶段”（SE-AN；n=41），通过痛苦（抑郁焦虑和压力量表，DASS≥60）和疾病持续时间（≥7 年）来确定。
在 12 个月时，患者报告了体重指数的大幅改善，ED 症状、情绪和工作/社会调整的小到中度改善，23.6%符合恢复标准。然而，被归类为 SE-AN 的患者在基线时报告了更高的获得强化服务的比例、更高的 ED 症状严重程度和更差的工作/社会调整，并且在 12 个月时工作/社会调整的改善率较低与“早期阶段”患者相比。
尽管目前的研究结果表明整体症状有所改善，但探索性结果突出了 AN 不同阶段的患者在病程和服务使用方面的明显差异，这表明需要考虑对临床决策进行分期。进一步研究区分 AN 的临床亚型并采用更个性化的方法可能确保服务和护理途径更符合患者的需求。
