Zhu James, Yang Yive, Touyz Stephen, Park Rebecca, Hay Phillipa
South West and North Coast Psychiatry Training Network, Sydney Local Health District, Sydney, NSW, Australia.
School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia.
Front Psychiatry. 2020 Mar 24;11:206. doi: 10.3389/fpsyt.2020.00206. eCollection 2020.
This Mini-Review presents recent research into evidence for psychological treatments for people with severe and enduring anorexia nervosa (SEAN). Two psychological therapies, specialist supportive clinical management (SSCM), and cognitive behavior therapy for anorexia nervosa (CBT-AN) have limited (one randomized controlled study) evidence of efficacy. Both have had adaptations for SEAN, notably with revision of the primary treatment goal of improved quality of life and full weight recovery a secondary goal. A major issue with existing studies is poor definition of SEAN, and the large deficit in research that has used an agreed definition of SEAN. In particular, it may be problematic to extrapolate from studies of people with either severe and/or enduring but not intractable or "resistant" illness. People with longstanding AN who have not received evidence based care should be offered this with an expectation of recovery. Similarly, people with SEAN may be offered care with judicious mitigation of expectations. In the future, trials should include people with SEAN clearly defined. Trials with a subsample of participants likely to have SEAN, if identified at randomisation, are an opportunity for secondary analyses of such participants. This would widen the evidence base for psychological treatments providing hope for people with this devastating illness. Finally, there is an urgent need not only to strengthen our existing knowledge with studies of sufficient power, but also, fundamentally, to derive novel conceptualizations of what "treatment" involves.
本综述介绍了近期针对重度及持续性神经性厌食症（SEAN）患者心理治疗证据的研究。两种心理疗法，即专科支持性临床管理（SSCM）和神经性厌食症认知行为疗法（CBT-AN），仅有有限的（一项随机对照研究）疗效证据。这两种疗法都针对SEAN进行了调整，特别是将主要治疗目标修订为改善生活质量，而将完全恢复体重作为次要目标。现有研究的一个主要问题是对SEAN的定义不明确，以及使用公认的SEAN定义的研究存在巨大差距。特别是，从对患有严重和/或持续性但并非难治性或“抵抗性”疾病的患者的研究中进行推断可能存在问题。对于长期患有神经性厌食症且未接受循证护理的患者，应提供这种护理并期望其康复。同样，对于SEAN患者，可以在明智地降低期望的情况下提供护理。未来，试验应纳入明确界定的SEAN患者。如果在随机分组时确定有一部分参与者可能患有SEAN，那么针对这部分参与者进行二次分析的试验是一个机会。这将拓宽心理治疗的证据基础，为患有这种毁灭性疾病的患者带来希望。最后，迫切需要不仅通过有足够效力的研究来加强我们现有的知识，而且从根本上得出对“治疗”所涉及内容的新颖概念。
