Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Deakin University, Food & Mood Centre, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
Int J Eat Disord. 2020 Aug;53(8):1280-1302. doi: 10.1002/eat.23322. Epub 2020 Jun 3.
Approximately 20% of people with Anorexia Nervosa (AN) and 10% with Bulimia Nervosa (BN) will eventually develop a long-standing illness. Although there is no set definition for Severe and Enduring eating Disorder (SE-ED), the common criteria relate to a long duration of the disorder and a number of unsuccessful treatment attempts. Research evidence for treatment of SE-ED remains limited, thus the objective of this systematic review was to describe different treatment interventions and their effects on SE-ED-related outcomes.
A systematic search for quantitative treatment studies of adult participants with SE-ED was conducted in June 2019 (PROSPERO, CRD42018115802) with no restriction on eating disorder type. Altogether, 2,938 studies were included for title and abstract screening.
After systematic searches and article screening, 23 studies (3 randomized controlled trials, 3 open-label studies, 8 naturalistic follow-up studies, 8 case series and case studies, and 1 partially blinded pilot study) were included in the analysis and data extraction. Methodological quality of the included studies was generally low. Inpatient treatment programs (n = 5) were effective in short-term symptom reduction, but long-term results were inconsistent. Outpatient and day-hospital treatment programs (n = 5) seemed promising for symptom reduction. Drug interventions (n = 5) showed some benefits, especially as adjuvant therapies. Brain stimulation (n = 6) led to improvements in depressive symptoms. Other treatments (n = 2) produced mixed results.
This is the first systematic review to examine all of the different treatment interventions that have been studied in SE-ED. The results will inform future interventions in research and clinical practice.
大约 20%的神经性厌食症（AN）患者和 10%的贪食症（BN）患者最终会发展为长期疾病。尽管严重和持久的饮食障碍（SE-ED）没有明确的定义，但常见的标准与该障碍的长期持续时间和多次治疗尝试失败有关。SE-ED 的治疗证据仍然有限，因此本系统评价的目的是描述不同的治疗干预措施及其对 SE-ED 相关结果的影响。
在 2019 年 6 月对成人 SE-ED 患者的定量治疗研究进行了系统检索（PROSPERO，CRD42018115802），对饮食障碍类型没有限制。共有 2938 项研究被纳入标题和摘要筛选。
经过系统搜索和文章筛选，共纳入 23 项研究（3 项随机对照试验、3 项开放标签研究、8 项自然随访研究、8 项病例系列和病例研究以及 1 项部分盲法试点研究）进行分析和数据提取。纳入研究的方法学质量普遍较低。住院治疗方案（n = 5）在短期症状缓解方面有效，但长期结果不一致。门诊和日间医院治疗方案（n = 5）似乎对症状缓解有帮助。药物干预（n = 5）显示出一些益处，尤其是作为辅助治疗。脑刺激（n = 6）导致抑郁症状改善。其他治疗（n = 2）产生了混合结果。
这是第一项检查 SE-ED 中已研究过的所有不同治疗干预措施的系统评价。结果将为未来的研究和临床实践中的干预措施提供信息。
