Solanto M V, Jacobson M S, Heller L, Golden N H, Hertz S
Division of Child and Adolescent Psychiatry, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
Pediatrics. 1994 Jun;93(6 Pt 1):989-91.
To ascertain the rate of weight gain of inpatients with anorexia nervosa under two behavioral contracts, differing in criterion weight gain required to earn increasing privileges.
Follow-up comparison of cohorts receiving different interventions.
Eating disorders service, operating on a general adolescent medicine unit.
Patients admitted consecutively who met the following criteria: (1) weight at least 15% less than that expected for age, sex, and height; (2) female gender; (3) absence of chronic medical illness; (4) hospital stay of at least 28 days. Twenty-two patients meeting these criteria were treated between July 1987 and October 1988, when contract 1 was in effect. This cohort of patients was compared with a group of 31 patients, also meeting the these criteria, who were treated between November 1988 and December 1991, when contract 2 was in effect.
The behavioral contract, signed by the patient on admission, specifies the minimum 4-day weight gain necessary to earn increasing ward privileges, such as use of phone, frequency of visits, etc. Contracts 1 and 2 differed only in the 4-day weight gain criterion: 0.8 lb (0.36 kg) and 1.2 lb (0.55 kg), respectively.
The results of analysis of covariance, with admission weight as the covariate, revealed a significant interaction between contract and day, such that patients receiving contract 2 gained weight more rapidly (0.36 lb/d) than those receiving contract 1 (0.20 lb/d). There was no confounding difference between groups in the use of psychotropic medication, and no complications of refeeding in either group.
Increasing the 4-day criterion weight gain from 0.8 to 1.2 lb in a behavioral contracting intervention was associated with a significant increase in the rate of weight gain, without an accompanying increase in complications of refeeding. This result simultaneously: (a) provides support for the efficacy of behavioral contracting and (b) reveals malleability in the rate of gain based on the targeted gain specified in the contract.
确定神经性厌食症住院患者在两种行为契约下的体重增加率，这两种契约在获得更多特权所需的标准体重增加方面有所不同。
对接受不同干预措施的队列进行随访比较。
在一个普通青少年医学科室开展工作的饮食失调服务机构。
连续入院且符合以下标准的患者：（1）体重比根据年龄、性别和身高预期的体重至少低15%；（2）女性；（3）无慢性内科疾病；（4）住院至少28天。1987年7月至1988年10月期间，有22名符合这些标准的患者接受了治疗，当时契约1有效。将这组患者与另一组31名同样符合这些标准的患者进行比较，这31名患者在1988年11月至1991年12月期间接受治疗，当时契约2有效。
患者入院时签署的行为契约规定了获得更多病房特权（如使用电话、探视频率等）所需的最低4天体重增加量。契约1和契约2仅在4天体重增加标准上有所不同：分别为0.8磅（0.36千克）和1.2磅（0.55千克）。
以入院体重为协变量的协方差分析结果显示，契约和天数之间存在显著交互作用，即接受契约2的患者体重增加更快（0.36磅/天），高于接受契约1的患者（0.20磅/天）。两组在使用精神药物方面没有混杂差异，两组均未出现再喂养并发症。
在行为契约干预中，将4天标准体重增加量从0.8磅提高到1.2磅与体重增加率显著提高相关，且未伴随再喂养并发症增加。这一结果同时：（a）为行为契约的有效性提供了支持；（b）揭示了基于契约中规定的目标增加量，体重增加率具有可塑性。
