World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders
World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders
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DOI：
10.3109/15622975.2011.602720
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发表时间：
2011-09-01
影响因子：
3.1
通讯作者：
Kasper, Siegfried
中科院分区：
文献类型：
--
作者：
Aigner, Martin;Treasure, Janet;Kasper, Siegfried
目标.饮食失调症的治疗是一个复杂的过程，不仅依赖于精神药物的使用，而且还应包括营养咨询、心理治疗和治疗出现的医疗并发症。在这篇综述中，根据现有文献，提出了饮食失调（神经性厌食症（AN），神经性贪食症（BN），暴食症（BED））的药物治疗建议。方法.饮食失调药物治疗指南基于1977年至2010年间发表的研究。文献检索包括：神经性厌食症、神经性贪食症、进食障碍和暴食症。许多化合物已被研究用于治疗进食障碍（AN：抗抑郁药（TCA、SSRIs）、抗精神病药、抗组胺药、促动力药、锌、锂、纳洛酮、人生长激素、大麻、可乐定和管饲; BN：抗抑郁药（TCA、SSRI、RIMA、NRI、其他AD）、抗癫痫药、奥丹司琼、d-芬氟拉明锂、纳曲酮、哌醋甲酯和光疗; BED：抗抑郁药（TCA、SSRI、SNRI、NRI）、抗癫痫药、巴氯芬、奥利司他、d-芬氟拉明、纳曲酮）。结果在AN 20随机对照试验（RCT）可以确定。对于锌补充剂，存在AN的B级证据。对于奥氮平，存在体重增加的B级证据。对于其他非典型抗精神病药物，有C级证据。在BN 36中，可以识别RCT。对于三环类抗抑郁药，A级证据存在中度风险-获益比。对于氟西汀，存在A级证据，具有良好的风险-获益比。对于托吡酯，可推荐2级。在BED 26中，可以识别RCT。对于SSRI舍曲林和抗癫痫药托吡酯，存在A级证据，但推荐等级不同。结论.需要更多的研究来改善饮食失调的治疗。特别是对于神经性厌食症，需要进一步的药物治疗策略。
Objectives. The treatment of eating disorders is a complex process that relies not only on the use of psychotropic drugs but should include also nutritional counselling, psychotherapy and the treatment of the medical complications, where they are present. In this review recommendations for the pharmacological treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED)) are presented, based on the available literature. Methods. The guidelines for the pharmacological treatment of eating disorders are based on studies published between 1977 and 2010. A search of the literature included: anorexia nervosa bulimia nervosa, eating disorder and binge eating disorder. Many compounds have been studied in the therapy of eating disorders (AN: antidepressants (TCA, SSRIs), antipsychotics, antihistaminics, prokinetic agents, zinc, Lithium, naltrexone, human growth hormone, cannabis, clonidine and tube feeding; BN: antidepressants (TCA, SSRIs, RIMA, NRI, other AD), antiepileptics, odansetron, d-fenfluramine Lithium, naltrexone, methylphenidate and light therapy; BED: antidepressants (TCA, SSRIs, SNRIs, NRI), antiepileptics, baclofen, orlistat, d-fenfluramine, naltrexone). Results. In AN 20 randomized controlled trials (RCT) could be identified. For zinc supplementation there is a grade B evidence for AN. For olanzapine there is a category grade B evidence for weight gain. For the other atypical antipsychotics there is grade C evidence. In BN 36 RCT could be identified. For tricyclic antidepressants a grade A evidence exists with a moderate-risk-benefit ratio. For fluoxetine a category grade A evidence exists with a good risk-benefit ratio. For topiramate a grade 2 recommendation can be made. In BED 26 RCT could be identified. For the SSRI sertraline and the antiepileptic topiramate a grade A evidence exists, with different recommendation grades. Conclusions. Additional research is needed for the improvement of the treatment of eating disorders. Especially for anorexia nervosa there is a need for further pharmacological treatment strategies.