Treatment of bulimia nervosa in a primary care setting.
Treatment of bulimia nervosa in a primary care setting.
复制标题
在初级保健机构中治疗神经性贪食症。
DOI：
10.1176/appi.ajp.161.3.556
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Parides,MichaelK
中科院分区：
文献类型：
--
作者：
Walsh,BTimothy;Fairburn,ChristopherG;Mickley,Diane;Sysko,Robyn;Parides,MichaelK
目的：作者的目的是确定在专门治疗中心已知对神经性贪食有效的治疗方法是否可以成功地用于初级卫生保健机构。他们检查了两种治疗暴食症的益处：1)氟西汀，一种抗抑郁药物，2)引导自助，一种适应认知行为疗法。方法将91例女性患者随机分为单独使用氟西汀组、单独使用安慰剂组、氟西汀加引导自助组、安慰剂加引导自助组。结果绝大多数患者未完成治疗试验；许多患者认为这种治疗方案过于苛刻，但也有人认为强度不够。与安慰剂组相比，氟西汀组的患者就诊次数更多，暴食和呕吐的减少更大，心理症状的改善也更大。没有证据表明有指导的自助会有好处。结论神经性贪食患者在初级保健机构的治疗受到高辍学率的阻碍。引导自助，一种基于认知行为疗法的心理治疗，似乎无效，但氟西汀治疗与更好的保留和显著的症状改善有关。
OBJECTIVEThe authors’ goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy.METHODNinety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help.RESULTSThe majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help.CONCLUSIONSThe treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.