Viljoen David, Ayton Agnes, Roberts Lyn, Twitchell Mollie, Collins Lorna
Ellern Mede Group, London, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
J Eat Disord. 2024 Oct 31;12(1):172. doi: 10.1186/s40337-024-01116-7.
This case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, longstanding anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk. Commentaries from two additional patients who have recovered from severe and longstanding anorexia nervosa are included.
The patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation proved effective.
In this paper, we describe the application of the I-CBTE model for individuals with severe, longstanding, and complex anorexia nervosa, using lived experience perspectives from three patients to inform clinicians. We also outline the methodology for adapting the model to different presentations of the disorder.
The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the benefit of the I-CBTE approach in patients with complex, longstanding eating disorder histories. Successful treatment also saved in excess of £360 k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs.
This case study, with commentaries from two patients with histories of severe and longstanding anorexia nervosa, provides a detailed description of the practical application of I-CBTE for patients with severe and longstanding eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to enhance existing treatment frameworks, potentially transforming the trajectory of those traditionally deemed treatment resistant.
We advocate the broader integration of CBT for EDs into specialist services across the care pathway to help improve outcomes for patients with complex eating disorders. Systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach is recommended. Future research should investigate the long-term effectiveness of I-CBTE through longitudinal studies. Patient feedback on experiences of integrated models of care such as I-CBTE is also needed. In addition, systematic health economics studies should be conducted.
本案例研究探讨了综合强化认知行为疗法（I-CBTE）在一名患有严重、长期神经性厌食症且伴有多种合并症（包括器质性幻觉症、复杂性创伤后应激障碍（CPTSD）和严重自残行为）的患者中的应用。如此复杂的病情往往导致患者在各医疗服务之间辗转，进而可能导致病情长期迁延不愈并增加死亡风险。文中还纳入了另外两名已从严重且长期的神经性厌食症中康复的患者的评论。
该患者在2000年发生创伤性脑损伤后患上了严重的神经性厌食症和幻觉症。尽管在英国和法国多次住院并使用了各种精神药物，但标准治疗在17年里均无效。然而，采用全团队方法以及强化、个性化心理治疗并结合营养康复的综合强化认知行为疗法（I-CBTE）被证明是有效的。
在本文中，我们描述了I-CBTE模型在患有严重、长期且复杂的神经性厌食症患者中的应用，利用三名患者的亲身经历为临床医生提供参考。我们还概述了使该模型适应该疾病不同表现形式的方法。
在过去6年里，该患者实现并维持了饮食失调的完全缓解，凸显了I-CBTE方法对有复杂、长期饮食失调病史患者的益处。仅通过避免进一步住院治疗（且未考虑其生活质量的改善情况），成功的治疗就节省了超过36万英镑。这表明该方法可以改善治疗效果并降低医疗成本。
本案例研究以及两名有严重且长期神经性厌食症病史患者的评论，详细描述了I-CBTE在患有严重且长期饮食失调并伴有复杂合并症以及广泛治疗史的患者中的实际应用。这为患者带来了希望，并为临床医生提供了一个框架，以加强现有的治疗框架，有可能改变那些传统上被认为对治疗有抵抗性的患者的病程。
我们主张将针对饮食失调的认知行为疗法更广泛地整合到整个护理路径的专科服务中，以帮助改善患有复杂饮食失调症患者的治疗效果。建议对多学科团队进行这种专门治疗方法的系统培训和监督。未来的研究应通过纵向研究调查I-CBTE的长期有效性。还需要患者对I-CBTE等综合护理模式的体验反馈。此外，应开展系统的卫生经济学研究。
