Department of Psychiatry, Columbia University Irving Medical Center, New York (Walsh, Attia); New York State Psychiatric Institute, New York (Walsh, Wang, Attia); Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York (Wang); Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto (Kaplan).
Am J Psychiatry. 2021 Sep 1;178(9):848-853. doi: 10.1176/appi.ajp.2021.21010026. Epub 2021 Jun 22.
There is long-standing interest in how best to define stages of illness for anorexia nervosa, including remission and recovery. The authors used data from a previously published study to examine the time course of relapse over the year following full weight restoration.
Following weight restoration in an acute care setting, 93 women with anorexia nervosa were randomly assigned to receive fluoxetine or placebo and were discharged to outpatient care, where they also received cognitive-behavioral therapy for up to 1 year. Relapse was defined on the basis of a priori clinical criteria. Fluoxetine had no impact on the time to relapse. In the present analysis, for each day after entry into the study, the risk of relapse over the following 60 days and the following 90 days was calculated and a parametric function was fitted to approximate the Kaplan-Meier estimator.
The risk of relapse rose immediately after entry into the study, reached a peak after approximately 60 days, and then gradually declined. There was no indication of an inflection point at which the risk of relapse fell precipitously after the initial peak.
This analysis highlights the fact that adult patients with anorexia nervosa are at increased risk of relapse in the first months following discharge from acute care, suggesting a need for frequent follow-up and relapse prevention-focused treatment during this period. After approximately 2 months, the risk of relapse progressively decreases over time.
长期以来，人们一直关注如何最好地定义厌食症的疾病阶段，包括缓解和康复。作者使用先前发表的研究数据，检查了在完全恢复体重后的一年中复发的时间过程。
在急性护理环境中恢复体重后，93 名患有厌食症的女性被随机分配接受氟西汀或安慰剂，并出院到门诊护理，在那里她们还接受了长达 1 年的认知行为治疗。复发是根据预先设定的临床标准定义的。氟西汀对复发时间没有影响。在本分析中，对于进入研究后的每一天，计算了接下来 60 天和接下来 90 天复发的风险，并拟合了一个参数函数来近似 Kaplan-Meier 估计器。
复发的风险在进入研究后立即上升，在大约 60 天后达到峰值，然后逐渐下降。没有迹象表明复发风险在初始峰值后急剧下降的拐点。
这项分析强调了一个事实，即急性护理出院后，成年厌食症患者在头几个月复发的风险增加，这表明在此期间需要频繁的随访和以预防复发为重点的治疗。大约 2 个月后，复发的风险随时间逐渐降低。
