Lydecker Janet A, Grilo Carlos M
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
Department of Psychology, Yale University, New Haven, CT, USA.
Psychol Med. 2021 Apr 14:1-9. doi: 10.1017/S0033291721001045.
Psychiatric comorbidity is common in binge-eating disorder (BED) but effects on treatment outcomes are unknown. The current study aimed to determine whether psychiatric comorbidity predicted or moderated BED treatment outcomes.
In total, 636 adults with BED in randomized-controlled trials (RCTs) were assessed prior, throughout, and posttreatment by doctoral research-clinicians using reliably-administered semi-structured interviews, self-report measures, and measured weight. Data were aggregated from RCTs testing cognitive-behavioral therapy, behavioral weight loss, multi-modal (combined pharmacological plus cognitive-behavioral/behavioral), and/or control conditions. Intent-to-treat analyses (all available data) tested comorbidity (mood, anxiety, 'any disorder' separately) as predictors and moderators of outcomes. Mixed-effects models tested comorbidity effects on binge-eating frequency, global eating-disorder psychopathology, and weight. Generalized estimating equation models tested binge-eating remission (zero binge-eating episodes during the past month; missing data imputed as failure).
Overall, 41% of patients had current psychiatric comorbidity; 22% had mood and 23% had anxiety disorders. Psychiatric comorbidity did not significantly moderate the outcomes of specific treatments. Psychiatric comorbidity predicted worse eating-disorder psychopathology and higher binge-eating frequency across all treatments and timepoints. Patients with mood comorbidity were significantly less likely to remit than those without mood disorders (30% v. 41%). Psychiatric comorbidity neither predicted nor moderated weight loss.
Psychiatric comorbidity was associated with more severe BED psychopathology throughout treatment but did not moderate outcomes. Findings highlight the need to improve treatments for BED with psychiatric comorbidities but challenge perspectives that combining existing psychological and pharmacological interventions is warranted. Treatment research must identify more effective interventions for BED overall and for patients with comorbidities.
精神疾病共病在暴食症（BED）中很常见，但对治疗结果的影响尚不清楚。本研究旨在确定精神疾病共病是否能预测或调节BED的治疗结果。
共有636名患有BED的成年人参与了随机对照试验（RCT），在治疗前、治疗期间和治疗后，由博士研究生临床医生使用可靠的半结构化访谈、自我报告量表和测量体重进行评估。数据来自测试认知行为疗法、行为减肥、多模式（药物联合认知行为/行为疗法）和/或对照条件的RCT。意向性分析（所有可用数据）将共病（分别为情绪、焦虑、“任何疾病”）作为结果的预测因素和调节因素进行测试。混合效应模型测试共病对暴食频率、全球饮食失调精神病理学和体重的影响。广义估计方程模型测试暴食缓解情况（过去一个月内无暴食发作；缺失数据视为未缓解）。
总体而言，41%的患者目前患有精神疾病共病；22%患有情绪障碍，23%患有焦虑症。精神疾病共病并未显著调节特定治疗的结果。精神疾病共病预测了所有治疗和时间点上更差的饮食失调精神病理学和更高的暴食频率。患有情绪共病的患者缓解的可能性明显低于没有情绪障碍的患者（30%对41%）。精神疾病共病既不能预测也不能调节体重减轻。
在整个治疗过程中，精神疾病共病与更严重的BED精神病理学相关，但并未调节治疗结果。研究结果强调需要改进对伴有精神疾病共病的BED的治疗，但对将现有心理和药物干预相结合的观点提出了挑战。治疗研究必须确定总体上对BED以及对伴有共病的患者更有效的干预措施。
