Diagnostic Crossover and Outcome Predictors in Eating Disorders According to DSM-IV and DSM-V Proposed Criteria: A 6-Year Follow-Up Study
Diagnostic Crossover and Outcome Predictors in Eating Disorders According to DSM-IV and DSM-V Proposed Criteria: A 6-Year Follow-Up Study
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DOI：
10.1097/psy.0b013e31820a1838
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发表时间：
2011-04-01
影响因子：
3.3
通讯作者：
Ricca, Valdo
中科院分区：
文献类型：
--
作者：
Castellini, Giovanni;Lo Sauro, Carolina;Ricca, Valdo
目的：在一项为期6年的随访研究中，评估接受个体认知行为疗法治疗的进食障碍（ED）患者的大样本临床病程。应用《精神疾病诊断和统计手册》第四版（DSM-IV）和DSM-V拟议标准评估了诊断交叉、恢复和复发。ED患者随着时间的推移而进入和退出疾病状态，表现出频繁的复发，表现出相关的终身精神病合并症，并在不同的诊断之间迁移。方法：共793例患者（包括神经性厌食症、神经性贪食症、暴食症和未另行说明的ED）在入院第一天、治疗结束时、治疗结束后3年和首次随访后3年进行了评价。通过面对面访谈收集临床数据;通过DSM-IV结构化临床访谈和进食障碍检查问卷进行诊断。结果：随着时间的推移，观察到不同诊断之间的复发率和交叉率一致。心境障碍合并症已被发现是诊断不稳定的一个重要决定因素，而形状的严重程度的关注代表了相关的结果修饰符。使用DSM-V提出的标准，大多数未另行说明的ED患者被重新分类，因此绝大多数寻求治疗的艾德患者将被纳入全面诊断。结论：在ED中，有不同的亚组患者显示不同的病程和结局。诊断不稳定涉及绝大多数患者。分类和维度方法的整合可以改善精神病理学调查和治疗选择。
Objective: To evaluate in a 6-year follow-up study the course of a large clinical sample of patients with eating disorders (EDs) who were treated with individual cognitive behavior therapy. The diagnostic crossover, recovery, and relapses were assessed, applying both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the DSM-V proposed criteria. Patients with EDs move in and out of illness states over time, display frequent relapses, show a relevant lifetime psychiatric comorbidity, and migrate between different diagnoses. Method: A total of 793 patients (including anorexia nervosa, bulimia nervosa, binge eating disorder, and EDs not otherwise specified) were evaluated on the first day of admission, at the end of treatment, 3 years after the end of treatment, and 3 years after the first follow-up. Clinical data were collected through a face-to-face interview; diagnosis was performed by means of the Structured Clinical Interview for DSM-IV and the Eating Disorder Examination Questionnaire was applied. Results: A consistent rate of relapse and crossover between the different diagnoses over time was observed. Mood disorders comorbidity has been found to be an important determinant of diagnostic instability, whereas the severity of shape concern represented a relevant outcome modifier. Using the DSM-V proposed criteria, most patients of EDs not otherwise specified were reclassified, so that the large majority of ED patients seeking treatment would be included in full-blown diagnoses. Conclusions: Among EDs, there are different subgroups of patients displaying various courses and outcomes. The diagnostic instability involves the large majority of patients. An integration of categorical and dimensional approaches could improve the psychopathological investigation and the treatment choices.