Deter H C, Herzog W
Department of Psychosomatics, University Medical Center Steglitz, Free University of Berlin, Germany.
Psychosom Med. 1994 Jan-Feb;56(1):20-7. doi: 10.1097/00006842-199401000-00003.
The long-term outcome of 84 anorexia nervosa patients was studied over a period of 12 years using global clinical ratings and differential physical findings in addition to standardized psychometric measurements. An unusual polarization into good and fatal outcomes was found, with a high recovery rate of 54% and a high mortality rate of 11%. When psychiatric and somatic comorbidity and psychosocial functioning were included in the assessment, the recovery rate was only 41% after 12 years. Clear cases of anorexia decreased steadily from 100% at clinical presentation to 67% after 2 years, 40% after 4 years, and 23% after 6 years. There was almost no further decline after the ninth year of follow-up (17%). Purging, physical symptoms, advanced age at clinical presentation, and a high social status were predictors for an unfavorable course. About 22% of the patients had suffered a relapse after remission. At first presentation, they were young and had a short duration of illness but showed severe psychiatric disorders. Results are discussed in terms of methodological and clinical issues involved in the long-term follow-up of anorexia nervosa patients.
对84名神经性厌食症患者进行了为期12年的长期随访研究，除了标准化心理测量外，还采用了整体临床评分和不同的体格检查结果。研究发现结果呈现出不寻常的两极分化，即良好结局和致命结局，康复率高达54%，死亡率为11%。当评估纳入精神和躯体合并症以及心理社会功能时，12年后的康复率仅为41%。明确的厌食症病例从临床表现时的100%稳步下降至2年后的67%、4年后的40%以及6年后的23%。随访第九年后几乎没有进一步下降（17%）。催吐、躯体症状、临床表现时年龄较大以及社会地位较高是不良病程的预测因素。约22%的患者在缓解后复发。初次就诊时，他们年龄较小、病程较短，但患有严重精神障碍。本文从神经性厌食症患者长期随访所涉及的方法学和临床问题方面对研究结果进行了讨论。
