Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response.
Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response.
复制标题
DOI：
10.1037/a0038635
复制
发表时间：
2015-04
影响因子：
5.9
通讯作者：
Gueorguieva, Ralitza
中科院分区：
文献类型：
--
作者：
Grilo, Carlos M.;White, Marney A.;Masheb, Robin M.;Gueorguieva, Ralitza
我们在一项随机临床试验中检查了暴饮暴食症（BED）肥胖患者的快速反应，该试验测试了抗肥胖药物和自助认知行为疗法（shCBT），单独和联合使用，在初级保健环境中。104例BED肥胖患者被随机分配到四种治疗之一：西布曲明，安慰剂，shCBT+西布曲明，或shCBT+安慰剂。治疗由全科初级保健医生提供，药物是双盲的。在整个治疗期间、治疗后（4个月）以及6个月和12个月随访时（即，随机化后16个月）。快速反应，定义为治疗第4周暴食减少≥65%，用于预测结局。47%的患者反应迅速。快速反应与人口统计学和基线临床特征无关。快速反应与治疗后（51% vs 9%，非快速反应者）、6个月（53% vs 23.6%）和12个月（46.9% vs 23.6%）随访时的暴食缓解显著相关。混合效应模型分析显示，快速反应与暴饮暴食、进食障碍精神病理学、抑郁症和体重减轻百分比的大幅下降显著相关。我们的研究结果基于在初级保健环境中接受药物治疗和自助CBT治疗的不同肥胖患者组，表明快速反应的患者在结束治疗后12个月的随访中取得了良好的临床结果。即使在低强度药物治疗和自助干预中，快速反应也是有临床意义结局的强有力预后指标。快速反应对床型ED的阶梯式护理治疗模式具有重要的临床意义。clinicaltrials.gov：NCT00537810
We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing anti-obesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings. 104 obese patients with BED were randomly assigned to one of four treatments: sibutramine, placebo, shCBT+sibutramine, or shCBT+placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research-clinicians monthly throughout treatment, post-treatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge-eating by the fourth treatment week, was used to predict outcomes. Rapid response characterized 47% of patients. Rapid response was unrelated to demographic and baseline clinical characteristics. Rapid response was significantly associated prospectively with remission from binge eating at post-treatment (51% versus 9% for non-rapid responders), 6-month (53% vs 23.6%), and 12-month (46.9% vs 23.6%) follow-ups. Mixed effects model analyses revealed rapid response was significantly associated with greater decreases in binge-eating, eating-disorder psychopathology, depression, and percent weight loss. Our findings, based on a diverse obese patient group receiving medication and self-help CBT treatments for BED in primary care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatments. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes even in low intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED. clinicaltrials.gov: NCT00537810
登录
查看更多内容
影响因子：
4.1
作者：
Reas, DL;Grilo, CM;Masheb, RM
通讯作者：
Masheb, RM
影响因子：
4.1
作者：
Grilo, Carlos M.;Masheb, Robin M.;Garcia, Rina
通讯作者：
Garcia, Rina
影响因子：
5.9
作者：
Hardy, GE;Cahill, J;Barkham, M
通讯作者：
Barkham, M
影响因子：
4.1
作者：
Safer DL;Joyce EE
通讯作者：
Joyce EE
影响因子：
5.5
作者：
Grilo, CM;Masheb, RM;Barry, DT
通讯作者：
Barry, DT