CESP, INSERM, UMR 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.
UFR des Sciences de la Santé Simone Veil (UVSQ), Versailles, France.
J Child Psychol Psychiatry. 2022 Nov;63(11):1368-1380. doi: 10.1111/jcpp.13583. Epub 2022 Feb 18.
Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus Systemic Family Therapy added to Treatment As Usual.
A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were available.
At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0% vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040).
Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.
随机对照试验表明，家庭疗法对青少年厌食症有效，但仍需要研究其长期有益效果。本文介绍了先前报告的一项随机对照试验的 54 个月随机分组后随访结果，该试验比较了两种住院后门诊治疗方案：单独常规治疗与常规治疗加系统家庭治疗。
连续纳入 60 例患有厌食症（DSM-IV）的女性青少年（n=60），随机分为两组（每组 30 例）。在前 18 个月中，常规治疗组接受多学科治疗。在另一组中，针对家庭内部动态的系统家庭治疗被添加到常规治疗中。在 54 个月时，主要结局定义为采用摩根和拉塞尔全球结局分类（良好或中等与不良）。次要结局包括全球结局评估量表评分、体重指数、闭经、住院次数、饮食障碍症状、精神病理学特征和家庭功能。采用意向治疗，采用最后观察向前结转（Last Observation Carried Forward）方法进行分析。59/60 例患者的数据可用。
在 54 个月时，与常规治疗相比，添加系统家庭治疗显示出显著的有利效果，主要结局分类为良好/中等的比例为 60%，而对照组为 31%（p=0.026），平均体重指数（p=0.048），月经恢复（70.0%对 40%，p=0.020）和精神状态评分（p=0.010）。系统家庭治疗组的家庭凝聚力评分较低（p=0.040）。
将重点关注家庭内部动态的系统家庭治疗添加到多维门诊治疗方案中，似乎可改善患有严重青少年厌食症的年轻女性的长期结局。
