成人神经性厌食的门诊个别心理治疗

目的神经性厌食是一种患病率和死亡率很高的疾病.本研究旨在评价关于成人和大龄青年(＞16岁)神经性厌食的门诊心理治疗的随机对照试验(RCT)证据.方法检索的策略包括:电子检索Medline,EXTRAMED,EMbase,PSYCLIT,Current,Contents,Cochrane Controlled Trials Register和Depression and Anxiety Neurosis Cochrane Group(CCDAN),检索日期为2002年9月、手检<国际饮食紊乱杂志>(International Jouma of Eating Disorders)以及所能找到的一切相关的论文;联系在此领域发表论文的各研究负责人,请求他们提供未发表的研究信息.纳入门诊个别心理治疗的成人神经性厌食的RCT,神经性厌食的诊断标准为DSM-V或者国际类似的标准.文献质量评价按照CCDAN标准执行.选择了以下一些结局指标,患者的身体情况,患者对饮食紊乱严重程度的观点和态度,人际交往能力和一些常见精神症状的严重程度.结局指标为连续变量的资料用标准均数差进行分析,结局指标为二分变量的资料用相对危险度进行分析.结果检索结果仅纳入6个小样本的研究,包括了2个以青少年和儿童为研究对象的试验,未能进行资料累积分析.由于评定结果时未使用盲法,所以存在偏倚的可能性.2个研究的结果显示:特殊的心理治疗比其它常规疗法有效,但是无一种疗法比其它疗法的疗效更持久.1个以"进食忠告"作对照的试验,100%的研究对象未完成试验.结论从本评价来看,没有一种特殊的心理治疗方法值得推荐.为何使用常规的治疗方法或者单独的"进食忠告"被接受的程度如此低,目前尚不清楚.此领域迫切需要设计严谨的大样本试验.

Individual Psychotherapy in the Outpatient Treatment of Adults with Anorexia Nervosa

Objective Anorexia nervosa is a disorder of high morbidity and significant mortality. The aim of the present review was to evaluate the evidence from randomized controlled trials for the efficacy of outpatient psychotherapies used in the treatment of older adolescents ( aged ＞ 16 years) and adults with anorexia nervosa. Methods The search strat egy comprised database searches of Medline, EXTRAMED, EMBASE, PSYCLIT, Current Contents, Cochrane Con trolled Trials Register and the Depression and Anxiety Neurosis Cochrane Group ( CCDAN), the search date was Novem ber 2002. A hand-search of The International Journal of Eating Disorders from its first issue up to March 2003, and the ref erence lists of all papers selected. Personal letters were sent to identified leading researchers published in the area, requesting information on trials that are unpublished. All randomized controlled trials of adult individual outpatient therapy for anorexia nervosa, as defined by the DSM-IV or similar international criterion, were included. Quality ratings were made according to the CCDAN criteria. A range of outcome variables were selected, including physical state, severity of eating disorder attitudes and behefs, interpersonal function, and general psychiatric symptom severity. Continuous outcome data comparisons were planned with the standardized mean difference statistic, and binary outcome comparisons planned with the relative risk statistic. Results Six small trials only, two of which included children or adolescents, were identified from the search and aggregation of data was not possible. Bias was possible due to lack of blinding of outcome assessments. The results in two trials suggested that "treatment as usual" or similar may be less efficacious than a specific psychotherapy. No specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial. Conclusions No specific approach can be recommended from this review. It is unclear why "treatment as usual" performed so poorly, or why dietary advice alone appeared so unacceptable. There is an urgent need for large well-designed trials in this area.