Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London.
South London and Maudsley NHS Foundation Trust, London, UK.
Curr Opin Psychiatry. 2024 Nov 1;37(6):404-416. doi: 10.1097/YCO.0000000000000964. Epub 2024 Sep 4.
Adult patients with severe anorexia nervosa often receive the same unsuccessful treatment without changes regarding the setting, the therapies, or nutritional interventions.
Settings where people with anorexia nervosa are treated include their general practitioner, an independent psychiatric practice, a community mental health team (CMHT), a specialized eating disorder outpatient service, eating disorder early intervention services, a highly intensive eating disorder outpatient or home treatment programme, eating disorder daycare, an inpatient eating disorder service, a general hospital or a general psychiatric hospital, or residential treatment. At a specialized eating disorder service, patients should be offered evidence-based psychotherapy for anorexia nervosa, dietary advice and physical health monitoring as a first step. Additionally, they may be allocated to a specific treatment pathway, family interventions and creative therapies. As a second step, clinicians may consider integrating interventions targeting psychiatric or physical comorbidities, medication for anorexia nervosa or noninvasive neurostimulation. After several years of futile treatment, deep brain stimulation (DBS) should be considered to prevent a chronic course of anorexia nervosa. Nutritional interventions can be escalated from nutritional counselling to nasogastric tube feeding. Patients who rely on nasogastric tube feeding might benefit from percutaneous endoscopic gastrostomy (PEG). Patients who vomit despite a nasogastric tube, might need nasojejunal tube feeding.
Treatment for people with anorexia nervosa should be regularly reviewed and, if necessary, escalated to avoid a chronic and longstanding disease course.
患有严重神经性厌食症的成年患者通常在治疗环境、治疗方法或营养干预方面没有变化，接受同样无效的治疗。
治疗神经性厌食症患者的场所包括他们的全科医生、独立的精神病诊所、社区心理健康团队 (CMHT)、专门的饮食失调门诊服务、饮食失调早期干预服务、高度密集的饮食失调门诊或家庭治疗计划、饮食失调日托、住院饮食失调服务、综合医院或综合精神病医院，或住院治疗。在专门的饮食失调服务中，应首先为患者提供基于证据的神经性厌食症心理治疗、饮食建议和身体健康监测。此外，他们可能会被分配到特定的治疗途径、家庭干预和创造性疗法。作为第二步，临床医生可能会考虑整合针对精神或身体合并症的干预措施、神经性厌食症的药物治疗或非侵入性神经刺激。经过多年无效的治疗后，应考虑深部脑刺激 (DBS) 以防止神经性厌食症的慢性病程。营养干预可以从营养咨询升级为鼻胃管喂养。依赖鼻胃管喂养的患者可能会受益于经皮内镜胃造口术 (PEG)。尽管有鼻胃管但仍呕吐的患者可能需要鼻空肠管喂养。
应定期审查神经性厌食症患者的治疗方法，并在必要时进行升级，以避免慢性和长期疾病病程。
