Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.
Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA (Emeritus).
Int J Eat Disord. 2021 Nov;54(11):1989-1997. doi: 10.1002/eat.23629. Epub 2021 Oct 22.
Stepped-care models of treatment are underexplored in eating disorders. To enhance treatment outcomes, and informed by literature about adaptations to family-based treatment (FBT), we developed an FBT-based stepped-care model for adolescents with anorexia nervosa (AN) that was consistent with family preference (i.e., tailored) and responsive to adolescent needs (i.e., intensity). The aim of this study was to evaluate the effectiveness of this model in terms of remission at end-of-treatment.
Adolescents (N = 82), aged 12-18 years (M = 15.1, SD = 1.8) and meeting Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for AN, were assessed at baseline, Weeks 24 and 48. FBT was tailored to family preference and clinical need, with 16-18 sessions by Week 24. This was followed by three FBT booster sessions or an extension of FBT plus booster sessions (Week 48). The primary outcome was defined as weight > 95% of %median body mass index plus within 1 SD of the Eating Disorder Examination (EDE) global score community norms.
Remission rates were 45.1% and 52.4% at Weeks 24 and 48, respectively. Commensurable improvements were evident across secondary outcomes (e.g., EDE subscale scores). As a reference point, remission rates compared positively with results from a recent randomized clinical trial from the same center and at the same time points (Week 24:45.1% vs. 32.1% and Week 48:52.4% vs. 30.2%). Controlling for propensity score, no statistically significant differences were observed.
This stepped-care model, designed to be responsive to the individual needs of adolescents and their families, achieved encouraging rates of remission. This study provides an important signal that supports future clinical trials of stepped-care models for adolescents with AN.
治疗的阶梯式护理模式在进食障碍中研究较少。为了提高治疗效果，并借鉴家庭为基础的治疗（FBT）的改编文献，我们为神经性厌食症（AN）的青少年开发了一种基于 FBT 的阶梯式护理模式，该模式符合家庭偏好（即量身定制），并能满足青少年的需求（即强度）。本研究旨在根据治疗结束时的缓解情况来评估该模式的有效性。
共评估了 82 名年龄在 12-18 岁（M=15.1，SD=1.8）之间且符合《精神障碍诊断与统计手册》第 5 版 AN 标准的青少年，分别在基线、第 24 周和第 48 周进行评估。FBT 根据家庭偏好和临床需要进行调整，第 24 周时达到 16-18 次。然后是三个 FBT 强化疗程或 FBT 加强化疗程的延长（第 48 周）。主要结局定义为体重>95%中位数体重指数加 EDE 全球评分社区正常值的 1SD。
第 24 周和第 48 周的缓解率分别为 45.1%和 52.4%。次要结局（如 EDE 分量表评分）也有明显改善。作为参考点，缓解率与同一中心和同一时间点的最近一项随机临床试验的结果相比是积极的（第 24 周：45.1%比 32.1%和第 48 周：52.4%比 30.2%）。控制倾向评分后，没有观察到统计学上的显著差异。
这种阶梯式护理模式旨在满足青少年及其家庭的个体需求，实现了令人鼓舞的缓解率。这项研究提供了一个重要的信号，支持未来对 AN 青少年进行阶梯式护理模式的临床试验。
