Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy.
Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
Int J Eat Disord. 2021 Mar;54(3):305-312. doi: 10.1002/eat.23428. Epub 2020 Nov 28.
The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT-E) in a real-world outpatient setting.
Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT-E. BMI and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20- and 60-week follow-ups for treatment completers.
Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating-disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow-ups. About half of the patients who completed treatment had a BMI ≥18.5 at the end of treatment and follow-ups.
CBT-E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real-world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment.
本研究旨在评估在现实世界的门诊环境中，采用强化认知行为疗法（CBT-E）治疗严重和极重度神经性厌食症患者的结局。
从一家提供门诊 CBT-E 的饮食失调服务诊所连续转介的患者中招募了 30 名年龄≥17 岁、患有神经性厌食症且 BMI<16 的患者。在入院时、治疗结束时以及治疗完成者的 20 周和 60 周随访时，记录 BMI 和饮食障碍检查问卷（EDE-Q）、简明症状量表（BSI）和临床损伤评估（CIA）评分。
20 名患者（66.7%）完成了治疗，体重明显增加（Cohen's f = 1.43），临床损伤（f = 1.26）、饮食障碍（f = 1.03）和一般心理病理（f = 0.99）的评分显著降低。在两次随访时，这些变化都保持稳定。约一半完成治疗的患者在治疗结束和随访时 BMI≥18.5。
CBT-E 似乎适合且有希望用于在现实临床环境中寻求治疗的严重和极重度神经性厌食症患者，前提是他们的身体状况稳定，且没有当前的重度抑郁发作或物质滥用；对于那些能够坚持全程门诊治疗的患者来说，它可能是住院治疗的有效替代方案。
