Mensi Martina M, Orlandi Marika, Rogantini Chiara, Provenzi Livio, Chiappedi Matteo, Criscuolo Michela, Castiglioni Maria C, Zanna Valeria, Borgatti Renato
Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
Front Psychiatry. 2021 Jun 4;12:653047. doi: 10.3389/fpsyt.2021.653047. eCollection 2021.
The present study presents an investigation of family functioning in the families of adolescents with severe restrictive eating disorders (REDs) assessed before and 6 months after a multidisciplinary family treatment program that combined psychodynamic psychotherapy, parental role intervention, and triadic or family-centered interventions. Nutritional counseling and neuropsychiatric monitoring of the overall treatment and care process were also provided. Family functioning was assessed using the clinical version of the Lausanne Trilogue Play (LTPc), a semi-structured procedure for observing family dynamics, previously validated for this patient population. The LTPc is divided into four phases. In phase 1, the mother interacts with the patient while the father assumes the role of observer. In phase 2, the father plans an activity with the patient while the mother observes. In phase 3, all the family members interact. Finally, in phase 4, the parents talk while the adolescent observes. A significant change emerged in family functioning after the treatment, but only for the interactive phase 2, when the father is required to interact with the daughter while the mother silently observes. The results of this study suggest that a relatively brief multidisciplinary treatment program may significantly improve family functioning in the families of patients diagnosed with severe REDs. Although appropriate clinical trials are needed to further test the efficacy of this treatment, the results also reinforce the concept that treatment programs targeting the individual patient and both the parents should be a first-line approach in adolescents with severe REDs.
本研究对患有严重限制性饮食失调（REDs）的青少年家庭的家庭功能进行了调查，这些家庭在一个多学科家庭治疗项目前后接受了评估，该项目结合了心理动力心理治疗、父母角色干预以及三元或家庭中心干预。还提供了营养咨询以及对整个治疗和护理过程的神经精神病学监测。家庭功能使用洛桑三部曲游戏临床版（LTPc）进行评估，这是一种用于观察家庭动态的半结构化程序，此前已针对该患者群体进行了验证。LTPc分为四个阶段。在第一阶段，母亲与患者互动，而父亲担任观察者的角色。在第二阶段，父亲与患者计划一项活动，而母亲进行观察。在第三阶段，所有家庭成员进行互动。最后，在第四阶段，父母交谈，青少年进行观察。治疗后家庭功能出现了显著变化，但仅在互动的第二阶段，即要求父亲与女儿互动而母亲默默观察时。本研究结果表明，一个相对简短的多学科治疗项目可能会显著改善被诊断患有严重REDs患者家庭的家庭功能。尽管需要进行适当的临床试验来进一步测试这种治疗的疗效，但结果也强化了这样一种观念，即针对个体患者及其父母的治疗项目应该是患有严重REDs青少年的一线治疗方法。
