神经性贪食症的强化营养咨询：氟西汀补充剂的作用？

Intensive nutritional counselling in bulimia nervosa: a role for supplementation with fluoxetine?

作者信息

Beumont P J, Russell J D, Touyz S W, Buckley C, Lowinger K, Talbot P, Johnson G F

机构信息

Department of Psychological Medicine, University of Sydney, New South Wales, Australia.

出版信息

Aust N Z J Psychiatry. 1997 Aug;31(4):514-24. doi: 10.3109/00048679709065073.

DOI:10.3109/00048679709065073

PMID:9272261

Abstract

OBJECTIVE

The aims of the paper are to determine whether nutritional counselling is associated with an improvement in bulimic symptomatology, whether this improvement is maintained during post-treatment follow-up, and whether the addition of fluoxetine 3 x 20 mg/day confers additional benefit.

METHOD

Psychological, pharmacological and combined psychopharmacological treatments of bulimia nervosa were reviewed briefly. Sixty-seven patients referred to specialist eating disorder services who fulfilled strict diagnostic criteria were treated with intensive nutritional counselling and randomly assigned to either fluoxetine 3 x 20 mg/day or placebo. After a 1-week 'wash-out', active treatment was given over 8 weeks, followed by post-treatment interviews at 12 and 20 weeks.

RESULTS

Both groups of patients improved significantly during treatment. In some respects, the fluoxetine group did slightly better as demonstrated by the items 'restraint', 'weight concern' and 'shape concern' (p < 0.05 vs p < 0.0001) on the Eating Disorder Examination (EDE). Fluoxetine patients decreased their energy intake and lost a modest amount of weight. They went on to regain weight during the follow-up period, returning to levels higher than they were initially. These patients also appeared more likely to have a recurrence of symptoms, as shown by the fall in percentage of binge-free patients and by changes in the EDE.

CONCLUSION

Nutritional counselling is an effective means of treating bulimia nervosa, with improvement maintained up to 3 months follow-up. The addition of fluoxetine may confer some benefit during active treatment, but its discontinuation may contribute to a higher rate of recurrence of symptoms post treatment. Of course, this study cannot be extrapolated to the efficacy of fluoxetine when used as the only form of treatment in patients for whom intensive nutritional counselling or other structured psychological programs are not available.

摘要

目的

本文旨在确定营养咨询是否与贪食症症状的改善相关，这种改善在治疗后的随访期间是否得以维持，以及每日服用3次、每次20毫克的氟西汀是否能带来额外益处。

方法

简要回顾了神经性贪食症的心理、药物及联合心理药物治疗。67名转诊至专业饮食失调服务机构且符合严格诊断标准的患者接受了强化营养咨询，并被随机分配至每日服用3次、每次20毫克的氟西汀组或安慰剂组。经过1周的“洗脱期”后，进行为期8周的积极治疗，随后在第12周和第20周进行治疗后访谈。

结果

两组患者在治疗期间均有显著改善。在某些方面，氟西汀组表现稍好，如饮食失调检查（EDE）中的“克制”“体重关注”和“体型关注”项目所示（与p < 0.0001相比，p < 0.05）。服用氟西汀的患者能量摄入减少，体重适度减轻。在随访期间，他们的体重又有所回升，恢复到高于初始水平。这些患者出现症状复发的可能性似乎也更高，如无暴食患者百分比的下降以及EDE的变化所示。