Li Zhuo, Dandil Yasemin, Toloza Cindy, Carr Anna, Oyeleye Oyenike, Kinnaird Emma, Tchanturia Kate
Department of Psychological Medicine, King's College London, Institute of Psychology, Psychiatry and Neuroscience, London, United Kingdom.
National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Front Psychiatry. 2020 Dec 1;11:599945. doi: 10.3389/fpsyt.2020.599945. eCollection 2020.
Audit data is important in creating a clear picture of clinical reality in clinical services, and evaluating treatment outcomes. This paper explored the data from an audit of a large national eating disorder (ED) service and evaluated the outcome of inpatient and day treatment programmes for patients with anorexia nervosa (AN) with and without autistic traits. Four hundred and seventy-six patients receiving treatment for AN at inpatient (IP), day-care (DC) and step-up (SU) programmes were assessed at admission and at discharge on the following measures: autistic traits, body-mass-index (BMI), ED symptoms, depression and anxiety symptoms, work and social functioning, and motivation for change. Outcomes were analyzed first at a within-group level based on change in mean scores and then at an individual level based on the clinical significance of improvement in eating disorder symptoms. Outcomes were compared between patients with high autistic traits (HAT) and low autistic traits (LAT) in each programme. The findings suggest that 45.5% of DC and 35.1% of IP patients showed clinically significant changes in ED symptoms following treatment. Co-occurring high autistic traits positively predicted improvement in ED symptoms in IP setting, but was a negative predictor in DC. In IP, more HAT inpatients no longer met the BMI cut-off for AN compared to LAT peers. In terms of general psychopathology, patients with AN and HAT exhibited more severe depression symptoms, anxiety symptoms and social functioning impairment than their LAT peers, and these symptoms stayed clinically severe after treatment. Patients with AN and hight autistic traits are more likely than their peers with low autistic traits to show weight restoration and improvement in ED systems after inpatient treatment. This reverses in DC, with high autistic trait patients less likely to improve after treatment compared to low autistic trait patients. Our results suggest that inpatient treatment with individualized and structured routine care may be an effective model of treatment for patients with AN and high autistic traits.
审核数据对于清晰呈现临床服务中的临床实际情况以及评估治疗结果至关重要。本文探讨了一项针对全国大型饮食失调（ED）服务的审核数据，并评估了有无自闭症特质的神经性厌食症（AN）患者的住院治疗和日间治疗项目的结果。对476名在住院（IP）、日间护理（DC）和强化治疗（SU）项目中接受AN治疗的患者在入院时和出院时进行了以下指标的评估：自闭症特质、体重指数（BMI）、ED症状、抑郁和焦虑症状、工作和社交功能以及改变的动机。首先基于平均得分的变化在组内水平分析结果，然后基于饮食失调症状改善的临床意义在个体水平分析结果。比较了每个项目中高自闭症特质（HAT）和低自闭症特质（LAT）患者的结果。研究结果表明，45.5%的DC患者和35.1%的IP患者在治疗后ED症状有临床显著变化。同时存在的高自闭症特质在IP环境中对ED症状的改善有正向预测作用，但在DC中是负向预测因素。在IP中，与LAT同龄人相比，更多有HAT的住院患者不再符合AN的BMI临界值。在一般精神病理学方面，患有AN和HAT的患者比他们的LAT同龄人表现出更严重的抑郁症状、焦虑症状和社交功能损害，并且这些症状在治疗后仍处于临床严重水平。与低自闭症特质的同龄人相比，患有AN和高自闭症特质的患者在住院治疗后更有可能恢复体重并改善ED症状。在DC中情况相反，与低自闭症特质患者相比，高自闭症特质患者治疗后改善的可能性较小。我们的结果表明，针对有AN和高自闭症特质的患者，采用个性化和结构化常规护理的住院治疗可能是一种有效的治疗模式。
