Predictors of treatment acceptance and completion in anorexia nervosa - Implications for future study designs
Predictors of treatment acceptance and completion in anorexia nervosa - Implications for future study designs
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DOI：
10.1001/archpsyc.62.7.776
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发表时间：
2005-07-01
影响因子：
--
通讯作者：
Kraemer, HC
中科院分区：
文献类型：
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作者：
Halmi, KA;Agras, WS;Kraemer, HC
背景：神经性厌食症的随机对照治疗研究非常少。目的：评估导致神经性厌食症治疗中不接受和未完成治疗的 2 种特定疗法及其组合的因素。设计：随机前瞻性研究。地点：威尔康奈尔医学中心，怀特普莱恩斯，纽约；明尼苏达大学，明尼阿波利斯；患者：122 名符合 DSM-IV 标准的神经性厌食症患者。干预措施：认知行为疗法、盐酸氟西汀或其组合治疗 1 年。主要结果指标：中途退出率和接受治疗（定义为治疗至少 5 周）。结果：在 122 例随机病例中，21 例（17%）退出；其余患者的总体退出率为 46% (56/122)。 122 例随机病例中有 89 例 (73%) 接受了治疗。在 41 名仅接受药物治疗的患者中，23 名（56%）接受了治疗。在另外 2 组中，接受率根据强迫性全神贯注分数的高低来区分（分别为 91% 和 60%）。治疗完成的唯一预测因素是高自尊，这与 51% 的治疗接受率相关。结论：治疗接受度和相对较高的退出率给神经性厌食症治疗研究带来了主要问题。不同的特征预测辍学率和接受率，在进行比较治疗试验之前需要仔细研究。
Context: There have been very few randomized controlled treatment studies of anorexia nervosa.Objective: To evaluate factors leading to nonacceptance and noncompletion of treatment for 2 specific therapies and their combination in the treatment of anorexia nervosa.Design: Randomized prospective study.Setting: Weill-Cornell Medical Center, White Plains, NY; University of Minnesota, Minneapolis; and Stanford University, Stanford, Calif.Patients: One hundred twenty-two patients meeting DSM-IV criteria for anorexia nervosa.Interventions: Treatment with cognitive-behavioral therapy, fluoxetine hydrochloride, or their combination for 1 year.Main Outcome Measures: Dropout rate and acceptance of treatment (defined as staying in treatment at least 5 weeks).Results: Of the 122 randomized cases, 21 (17%) were withdrawn; the overall dropout rate was 46% (56/122) in the remaining patients. Treatment acceptance occurred in 89 (73%) of the 122 randomized cases. Of the 41 assigned to medication alone, acceptance occurred in 23 (56%). In the other 2 groups, acceptance rate was differentiated by high and low obsessive preoccupation scores (rates of 91% and 60%, respectively). The only predictor of treatment completion was high self-esteem, which was associated with a 51% rate of treatment acceptance.Conclusion: Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa. Differing characteristics predict dropout rates and acceptance, which need to be carefully studied before comparative treatment trials are conducted.