Anorexia Nervosa: The Importance of Treatment Intensity

描述（由申请人提供）：这项R34探索性研究资助的目的是开始获得关于神经性厌食症（AN）治疗的急需的对照数据。AN是一种严重的疾病，与大量的发病率和死亡率相关。近年来，由于经济压力限制了医院治疗，治疗方法发生了重大变化，而且没有关于这些变化影响的严格数据。事实上，对于治疗这种具有挑战性的疾病的基本组成部分，没有基于证据的建议。本申请提出了一项针对AN患者体重恢复的两种治疗方法的小型随机试验。延长住院患者体重恢复治疗将与“现实世界”的治疗进行比较，主要包括强化门诊方法。项目的头六个月将用于开发和手动操作这两种治疗方法。住院治疗将以纽约州精神病研究所提供的治疗为基础，这是一家国家支持的研究型医院。“现实世界”的治疗将以约翰霍普金斯医疗机构备受推崇和成功的治疗方案为基础。霍普金斯大学的项目包括较短的住院时间，随后是一段时间的日间项目治疗，主要由健康保险计划报销。霍普金斯模型将适用于NYSPI的手动和执行治疗的目的。两家管理式医疗公司的代表将参与研究治疗开发，以确保该计划与“现实世界”的实践和报销一致。这可能是一种有时间限制的、有顺序的治疗，比医院的治疗方案更少。在项目最后两年半的时间里，纽约州精神病学研究所将进行一项小型的住院患者体重恢复随机对照试验和一项不那么密集的“现实世界”治疗模型。随访信息将在随机分组后的18个月内收集。结果测量将包括体重、饮食行为和相关的精神病理，以及研究期间的服务利用情况。

DESCRIPTION (provided by applicant): The aim of this R34 Exploratory Research Grant is to begin to obtain much needed controlled data regarding the treatment of anorexia nervosa (AN). AN is a serious disorder and is associated with substantial morbidity and mortality. Treatment has changed significantly in recent years due to economic pressures that have limited hospital-based treatments and there are no rigorous data regarding the impact of these changes. In fact, there are no evidence-based recommendations regarding the essential components of treatment for this challenging disorder. This application proposes a small randomized trial of two treatments for weight restoration in patients with AN. Extended inpatient weight-restoration treatment will be compared to a "real world" treatment that includes primarily an intensive outpatient approach. The initial six months of the project will be used to develop and manualize the two treatment approaches. The inpatient treatment will be based on the treatment offered by The New York State Psychiatric Institute, a state-supported research hospital. The "real world" treatment will be based on the well regarded and successful treatment program at Johns Hopkins Medical Institution. The Hopkins program consists of a shorter inpatient stay followed by a period of day program treatment, reimbursed primarily by health insurance plans. The Hopkins model will be adapted for the purposes of manualization and execution of the treatment at NYSPI. Representatives from two managed care companies will participate in the study treatment development in order to assure that the program is consistent with "real world" practice and reimbursement. It will likely be a time-limited, sequenced treatment that will be less treatment-intensive than will the hospital program. In the final 2.5 years of the project, a small randomized comparison trial of inpatient weight restoration and a less intensive model of "real world" treatment will be conducted at The New York State Psychiatric Institute. Follow-up information will be collected over an 18-month period following randomization. Outcome measures will include weight, eating behaviors and associated psychopathology, as well as service utilization during the study period.