厌食症患者情绪障碍与家庭功能关系的对照研究

目的 探讨神经性厌食症患者发病的情绪障碍及家庭功能之间的关系.方法 使用症状自评量表(SCL-90),家庭功能量表(FAD)对29例神经性厌食症患者的心理特征及其家庭功能进行评定,并与大学生样本进行对照研究.结果 神经性厌食症患者SCL-90中躯体化,强迫,焦虑,抑郁,敌意,恐惧,偏执,精神病性评分均高于正常对照,差异有统计学意义(P<0.05).FAD问题解决,沟通,情感反应,情感介入,总的功能评分均显著高于正常对照,差异有统计学意义(P<0.05).家庭功能各因子与SCL-90各因子存在相关.结论 神经性厌食患者对情绪障碍更易感,并且存在家庭功能的失调,并且其情绪障碍与家庭功能可以互相影响.     

利培酮合并心理治疗神经性厌食症18例临床观察

目的 观察利培酮治疗神经性厌食症的临床疗效。方法 对18例神经性厌食症患者用利培酮系统治疗16周，辅以心理治疗。结果 14例患者体重增加10％以上，有效率为77．8％；10例患者体重增加20%以上，显效率为55．6%。副反应轻微，主要为震颤、嗜睡和便秘。结论 利培酮合并心理治疗神经性厌食症患者，疗效确切且副反应小。     

神经性厌食症与家庭治疗研究

本文从神经性厌食症的临床意义、流行学、与家庭系统的关系、对家庭的影响及神经性厌食症患者的家庭特征等方面进行总结和讨论。     

脑深部电刺激治疗难治性神经性厌食症

目的 探讨脑深部电刺激(DBS)治疗难治性神经性厌食症.方法 4例经过心理及药物治疗无效的难治性神经性厌食症患者,接受磁共振导向立体定向双侧伏隔核DBS植入,术后给予持续慢性高频电刺激.采用身体质量指数(BMI)及其他精神科量表如Yale - Brown强迫症量表(YBOCS)、汉密尔顿焦虑量表(HAMA)评估DBS治疗难治性神经性厌食症的长期疗效.结果 所有患者随访9-50个月(平均39个月).经过3-12个月的慢性电刺激,患者BMI由术前的平均11.4增加到17.9,同时进食行为及强迫、焦虑症状也明显缓解.4例患者的月经均完全恢复正常.其中2例在术后30个月后刺激器因电池耗尽而取出,患者治疗效果稳定,所有患者未出现不良反应及手术并发症.结论 伏隔核DBS是治疗难治性神经性厌食症有效及安全的方法,不仅可改善进食障碍,同时对伴随的强迫焦虑症状也有明显改善.     

立体定向手术干预伏隔核治疗神经性厌食症

目的通过立体定向毁损术及脑深部电刺激能有效治疗神经性厌食症。方法共8例罹患神经性厌食症的患者通过立体定向手术干预伏隔核治疗神经性厌食症（其中6例患者接受双侧伏隔核毁损术,2例患者接受双侧伏隔核脑深部电刺激）。患者术前均接受正规的抗精神类药物及心理、营养治疗无效。患者术前及术后接受BMI指数、YBOCS,HAMA,HAMD量表的测定,评价疗效。结果 8例患者术后BMI指数均得到明显改善（P〈0.01）,除1名患者外,其余患者BMI指数均大于18.5kg/m^2。接受双侧伏隔核毁损术的患者术后YBOCS,HAMA,HAMD指数均得到立即改善,接受双侧伏隔核脑深部电刺激的患者术后经过程控,各项评定也均得到有效控制。结论伏隔核是治疗神经性厌食症的有效靶点,立体定向手术干预伏隔核可有效改善神经性厌食症患者的各项症状。     

从香港患者看神经性厌食症的跨文化差异

本文总结香港７０例神经性厌食症的临床特点，发现部分患者缺乏肥胖恐惧。对中、西方厌食症的差异进行了讨论，提出应对神经性厌食症的诊断及社会因素进行深入的跨文化研究．     

神经性厌食症15例临床分析

神经性厌食症１５例临床分析杨勇神经性厌食症系心理因素所致的进食障碍。作者于１９９３年３月～１９９６年８月期间在门诊收集符合ＣＣＭＤ—２诊断标准的神经性厌食症女性患者１５例，现就其临床资料报告如下。１临床资料１．１一般资料本组１５例均为女性，年龄１４～...     

氢化可的松拮抗剂治疗神经性厌食症8例报告

Walsh(1981)发现神经性厌食发病时 ,体液中氢化可的松水平是增高的 ,但当临床症状缓解后 ,其水平则同步下降 ,表明体液中高浓度的氢化可的松与神经性厌食有关。Par sons等 (1985 )首次报道用氢化可的松拮抗剂治疗神经性厌食症有效[1 ] 。为了验证上述结果 ,本文采用氢化可的松拮抗剂治疗神经性厌食症 8例 ,现将结果报道于后。1　对象和治疗1 1　对象　 1990年以来 ,我院共收治了 8例神经性厌食症患者 ,均符合CCMD - 3神经性厌食症标准。 8例均系女性 ,年龄 13～ 2 1岁 ,平均年龄 16 5岁 ,均为城市青少年学生。病程最短者 3个月 ,最长者 …     

神经性厌食症女性的性问题

早在1954年就有人断定神经性厌食症影响病人的性欲,但最近有人对这些病人作大样本的研究,还不能肯定性欲与此病之间有联系。本文旨在了解治疗神经性厌食症女性患者的性心理情况。方法:连续住入精神科病房的神经性厌食症女性病人30例,均符合DSM-Ⅲ诊断标准。平均年龄24岁(18～39岁),11例月经规律,4例轻度或重度紊乱,15例继发性闭经。     

认知行为疗法治疗12例神经性厌食症的效果分析

神经性厌食症是与心理因素密切相关的疾病。它因节食、拒食行为而导致体重下降，月经紊乱等，重者可衰竭、死亡［１］。本文对神经性厌食症应用认知行为疗法治疗作一分析，现报道如下。１资料与方法病例来源于本院住院治疗的神经性厌食症共１２例，均符合ＣＣＭＤ—２—Ｒ...     

An evaluation of family therapy in anorexia nervosa and bulimia nervosa

A controlled trial comparing family therapy with individual supportive therapy in anorexia nervosa and bulimia nervosa was undertaken. Eighty patients (57 with anorexia nervosa; 23 with bulimia nervosa) were first admitted to a specialized unit to restore their weight to normal. Before discharge, they were randomly allocated to family therapy or the control treatment (individual supportive therapy). After one year of psychological treatment, they were reassessed, using body weight, menstrual function, and ratings on the Morgan and Russell scales. Family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years. A more tentative finding was the greater value of individual supportive therapy in older patients. To our knowledge, this is the first controlled trial of family therapy in anorexia nervosa and clarifies the specific indications for this treatment.     

The place of family therapy in the treatment of anorexia nervosa

There has been widespread, uncritical support for family therapy as the treatment of choice for all anorexia nervosa patients since Minuchin's report in 1976, but recent research has not been able to validate Minuchin's theories about the functioning of anorexia nervosa families. In the only controlled trial to date, the efficacy of family therapy was found to be superior to that of individual therapy, but only in younger patients. Selection factors for family therapy in the treatment of anorexia nervosa are illustrated by a report on 23 consecutive referrals to an eating disorder clinic. Although knowledge of the patient's family was an essential part of the assessment for all patients, and nuclear family sessions were considered to be highly desirable for all patients, in only six instances was nuclear family therapy a major component of treatment. These patients were mainly younger, had a recent onset of illness and lived in an intact nuclear family with co-operative parents.     

Emerging psychotherapies for eating disorders

Eating disorders are serious illnesses associated with significant medical and psychological sequelae and, in the case of anorexia nervosa, significant mortality. Established psychotherapies such as cognitive-behavioral therapy and interpersonal therapy are effective for many patients with eating disorders. However, these treatments fail to yield full long-term remission in a substantial number of patients. There is a need for novel psychotherapeutic approaches for patients with eating disorders. The authors review three promising new treatment approaches in the field of eating disorders. Motivational enhancement therapy is based on established motivational principles for treating patients with addictive disorders and has been adapted as an early component of treatment for patients with anorexia nervosa and bulimia nervosa. Dialectical behavioral therapy was initially developed for the treatment of borderline personality disorder and has been successfully applied to patients with binge eating. A novel form of family therapy, the Maudsley family treatment for adolescents with anorexia nervosa, has been newly manualized, and studies using this treatment are ongoing. For each treatment, the authors review the theory and techniques of treatment and then go on to review existing data on treatment efficacy.     

Lifetime substance abuse, family history of alcohol abuse/dependence and novelty seeking in eating disorders: Comparison study of eating disorder subgroups

Aim:  To assess lifetime substance abuse, family history of alcohol abuse/dependence, and novelty seeking in three different eating disorder groups (anorexia nervosa–restrictive; anorexia nervosa–binge eating/purging; anorexia nervosa to bulimia nervosa).
Method:  A total sample of 371 eating disorder patients participated in the current study. Assessment measures included the prevalence of substance abuse and family history of alcohol abuse/dependence as well as the novelty-seeking subscale of the Temperament and Character Inventory–Revised.
Results:  Significant differences across groups were detected for lifetime substance abuse, with anorexia nervosa–restrictive individuals exhibiting a significant lower prevalence than the anorexia nervosa to bulimia nervosa and anorexia nervosa–binge eating/ purging patients ( P  < 0.01). For family history of alcohol abuse/dependence the same pattern was observed ( P  = 0.04). Novelty seeking was associated with substance abuse ( P  = 0.002), with the anorexia nervosa to bulimia nervosa group exhibiting significantly higher scores on the novelty-seeking scale than the other two groups ( P  < 0.001). But family history of alcohol abuse/dependence was not related to novelty seeking ( P  = 0.092).
Conclusion:  Lifetime substance abuse appears to be more prevalent in anorexia nervosa patients with bulimic features. Higher novelty-seeking scores may be associated with diagnosis cross-over.     

Troubles bipolaires et anorexie mentale : une étude clinique

PurposeAnorexia nervosa is often accompanied by comorbid mood disorders, in particular depression, but individual or family history of bipolar disorders has not frequently been explored in anorexia nervosa. The objectives of the present study were: (1) to assess the frequency of bipolar disorders in patients with anorexia nervosa hospitalized in adolescence and in their parents, (2) to determine whether the patients with a personal or family history of bipolar disorders present particular characteristics in the way in which anorexia nervosa manifests itself, in their medical history, in the secondary diagnoses established, and in the treatments prescribed.MethodOverall, 97 female patients aged 13 to 20 hospitalized for anorexia nervosa and their parents were assessed. The diagnoses of anorexia nervosa and bipolar disorders were established on the basis of DSM-IV-TR criteria.ResultsA high frequency of type II and type V bipolar disorders was observed. The patients with anorexia nervosa and presenting personal or family histories of bipolar disorder had an earlier onset of anorexia nervosa, more numerous hospitalizations, a longer time-lapse between anorexia nervosa onset and hospitalization, more suicide attempts and more psychiatric comorbidities.ConclusionThe occurrence of anorexia nervosa–bipolar disorders comorbidity appears to be considerable and linked to the severity of anorexia nervosa, raising the issue of the relationship between anorexia nervosa and bipolar disorders.     

Efficacy of intervention with externalization therapy for eating disorders]

Externalization has been one of the effective methods in the fields of brief therapy, family therapy, and psycho-education in recent years. In this study, we investigated the efficacy of intervention with externalization at the first stage of therapy in 25 patients with eating disorders. The subjects consisted of 11 patients with anorexia nervosa (AN) and 14 with bulimia nervosa (BN). The Eating Disorder Inventory (EDI) was evaluated at the first session, the 10th session, and six months later. The obtained results showed intervention with externalization resulted in significant decreases in not only total EDI score but also all the EDI subscale scores. We also found that there were great differences between the EDI subscale scores of anorexia nervosa and bulimia nervosa patients. Therapy was significantly less effective for patients with anorexia nervosa than for those with bulimia nervosa, and much less effective for the restricting type of anorexia nervosa. In addition, all the EDI subscale scores were significantly decreased, irrespective of the complication of personality disorder. The efficacy of intervention with externalization continued for six months. Especially in patients with anorexia nervosa, there were significant decreases in the EDI subscale scores when compared with the scores in the 10th session. The present findings indicates that initial intervention with externalization is effective for treating eating disorders, regardless of the severity of illness.     

Pragmatic information on the eating disorders

Anorexia nervosa and bulimia are the prevalent eating disorders in adolescence and can well be regarded as a public health problem. Information on weight history, menstrual history, eating behavior, purging behavior, preoccupation with and fear of weight gain, activity level, depressive symptomatology, and impulsive behaviors is necessary in order to make the diagnosis of anorexia nervosa or bulimia. It is important to remember that bulimia patients have a fluctuation of weight within a normal weight range and usually do not have amenorrhea. The treatment of anorexia nervosa must include medical management, psychotherapy, behavioral therapy, and family therapy. Beginning treatment with outpatient therapy may be successful in adolescents who have a good prognosis and whose parents are willing to cooperate in family therapy. If a patient remains underweight, then she is not being effectively treated for the anorexia nervosa. Most patients will need an initial hospitalization for nutritional rehabilitation and continued outpatient therapy. Recently, bulimia has been recognized as a discrete disorder. Treatment approaches are currently being developed for this disorder and include behavioral techniques, group therapy, antidepressant and anticonvulsant medication, and psychotherapy.     

Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa

OBJECTIVE: This study provides what the authors believe is the first empirical evaluation of cognitive behavior therapy as a posthospitalization treatment for anorexia nervosa in adults. METHOD: After hospitalization, 33 patients with DSM-IV anorexia nervosa were randomly assigned to 1 year of outpatient cognitive behavior therapy or nutritional counseling. RESULTS: The group receiving nutritional counseling relapsed significantly earlier and at a higher rate than the group receiving cognitive behavior therapy (53% versus 22%). The overall treatment failure rate (relapse and dropping out combined) was significantly lower for cognitive behavior therapy (22%) than for nutritional counseling (73%). The criteria for "good outcome" were met by significantly more of the patients receiving cognitive behavior therapy (44%) than nutritional counseling (7%). CONCLUSIONS: Cognitive behavior therapy was significantly more effective than nutritional counseling in improving outcome and preventing relapse. To the authors' knowledge, these data provide the first empirical documentation of the efficacy of any psychotherapy, and cognitive behavior therapy in particular, in posthospitalization care and relapse prevention of adult anorexia nervosa.     

A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa

OBJECTIVE: To compare the effectiveness of behavioral family systems therapy (BFST) with that of ego-oriented individual therapy (EOIT) as treatments for adolescents with anorexia nervosa. METHOD: Thirty-seven adolescents meeting DSM-III-R criteria for anorexia nervosa were randomly assigned to receive BFST or EOIT, in addition to a common medical and dietary regimen. In BFST, the family was seen conjointly, the parents were placed in control of the adolescent's eating, distorted beliefs were targeted through cognitive restructuring, and strategic/behavioral interventions were used to change family interactions. In EOIT, the adolescent was seen individually, with an emphasis on building ego strength and uncovering the dynamics blocking eating; parents were seen collaterally. Measures administered before, after, and at 1-year follow-up tapped body mass index, menstruation, eating attitudes, ego functioning, depression, and family interactions. RESULTS: BFST produced greater weight gain and higher rates of resumption of menstruation than EOIT. Both treatments produced comparably large improvements in eating attitudes, depression, and eating-related family conflict, but very few changes occurred on ego functioning. CONCLUSIONS: BFST and EOIT proved to be effective treatments for adolescents with anorexia nervosa, but BFST produced a faster return to health.     

Les stratégies d'attachement, leur transmission et le fonctionnement familial d'adolescentes anorexiques mentales

Bowlby's attachment theory emphasizes the importance of early child-environment interactions in order to develop “internal working models”, secure or insecure, which will influence future relationships with caregivers, peers and other members of the environment. Many factors are involved in the development of eating disorders, and for some authors anorexia nervosa may also be considered as a form of psychological regulation. It is surmised that this type of regulation facilitates coping with occurrences of separation during the “separation-individuation” stage of the adolescent period in a specific group of adolescents who are vulnerable to separation or transition events. During puberty, it has been observed that this vulnerable group displays a specific pattern of attachment or modification of prior internal models of attachment. Following Mary Ainsworth's paradigm, many studies have therefore suggested that subjects with eating disorders show “insecure” attachment, and more precisely “avoidant” attachment in anorexia nervosa. Recent studies on family functioning in anorexia nervosa have also suggested specific types of family interactions, enmeshed and rigid, and some authors such as Stevenson-Hinde hypothesized a link between family functioning and attachment strategies. We decided to study a population of young anorexic girls in terms of their quality of attachment and family interactions, and hypothesized that attachment types in subjects with anorexia nervosa would be associated with maternal type of attachment and specific family functioning. This paper describes a study conducted on a cohort of 29 subjects from the Outpatient Eating Disorder Unit of Robert Debré Hospital in Paris. Ten female adolescents with a mean age of 14 years and a DSM-IV diagnosis of restrictive anorexia nervosa, their ten mothers and nine fathers agreed to participate in the study. The main objective was to examine links between attachment strategies in outpatients with anorexia nervosa, their mode of transmission and family functioning. Two self-questionnaires were administered: Ca-mir and FACES III. Results suggested that patients and families perceived themselves as having secure attachment and that attachment transmission stemmed from the paternal rather than the maternal side. Our results do not confirm those from previous studies on attachment and anorexia nervosa. Young anorectic patients from our cohort perceived themselves as secure whereas in the literature attachment is described as insecure. Several reasons may explain this result. Our cohort of patients had a mean age of 14 years; previous studies were performed on older adolescents or young adults and it is possible that attachment strategies change over time, especially during adolescence when the subject is faced with the separation-individuation stage. At the beginning of puberty, young subjects may display a secure attachment which may be modified towards the end of puberty. Bowlby has suggested that attachment may be sensitive to psychotherapy; our subjects were involved in outpatient treatment or family therapy that may also have influenced their attachment strategies. Mothers from our group described insecure attachment but surprisingly it is the fathers' attachment type which is supposed to be transmitted to daughters. Perhaps these insecure women have chosen specific companions to protect themselves and their children? In opposition to Stevenson-Hinde's hypothesis, we did not find a correlation between attachment strategies and family functioning. Nevertheless, our results have to be interpreted with caution because of methodological biases. Our cohort is small, we have no control group and the “gold instrument” for evaluating attachment is the Adult Attachment Interview that is not validated as a French instrument. In conclusion, results from this study do not confirm the existence of relationships between insecure attachment and anorexia nervosa, or attachment type and family functioning, in young subjects. Future controlled studies are needed in order to explore attachment and psychopathology in children and adolescents, links between attachment, family functioning and internal temperamental dimensions.