Family Therapy and Fluoxetine in the Treatment of Adolescent Anorexia Nervosa

描述（由申请人提供）：本提案的长期目标是加强神经性厌食症（AN）的治疗和结果，并发展一个研究和培训中心网络，以支持神经性厌食症的创新研究。对AN治疗的研究落后于其他疾病，甚至其他饮食失调，如神经性贪食症，因此在大规模研究中测试潜在有效的治疗方法，为未来的研究提供基线是很重要的。本提案的重点是青少年的AN。成功的早期治疗可能会降低慢性AN的患病率，因为它的发病率和死亡率都很高，而且医疗费用也很高。青少年AN最有希望的治疗方法是一种特殊形式的家庭治疗（莫兹利方法），在这里被称为行为家庭治疗（BFT）。这种治疗的重点是紊乱的饮食行为，这是AN的特征，并使父母能够重新喂养他们的孩子。此外，有初步证据表明氟西汀可能有助于减少共病精神病理和增强AN的维持。然而，目前还没有氟西汀治疗青少年AN的安慰剂对照研究。此外，尽管有一些关于BFT的小规模研究，但还没有与另一种形式的家庭治疗进行对照比较。因此，我们建议使用系统家庭治疗（SFT）来代表社区中实践的家庭治疗类型。我们建议将240名12-18岁的AN青少年及其家人随机分为4组：BFT +安慰剂组；BFT +氟西汀；SFT +安慰剂；和SFT +氟西汀。在家庭治疗结束后继续用药6个月，以评估药物对维持治疗效果的影响。治疗和评估将在6个临床站点进行，每个站点40名受试者，有单独的数据和协调中心。治疗地点将遵循共同的评估和治疗方案，并由协调中心对招募、治疗、评估和人体受试者程序进行详细监测。本研究的结果应该为临床医生提供关于青少年AN的最佳治疗方法的指导。从公共卫生的角度来看，为青少年开发有效的治疗方法将降低与慢性AN相关的发病率、死亡率和高成本。

DESCRIPTION (provided by applicant): The long-term objective of this proposal is to enhance the treatment and outcome of anorexia nervosa (AN) and to develop a network of research and training centers to support innovative research in AN. Research on the treatment of AN has lagged that of other conditions, even other eating disorders such as bulimia nervosa, hence it is important to test potentially effective treatments in a large scale study so as to provide a baseline for future studies. The focus of this proposal is on adolescent AN. Successful early treatment is likely to reduce the prevalence of chronic AN with its high rates of morbidity and mortality and high health care costs. The most promising treatment for adolescent AN is a specific form of family therapy, (the Maudsley approach) called here, behavioral family therapy (BFT). This treatment is focused on the disordered eating behavior that characterizes AN and enables parents to refeed their child. Additionally, there is preliminary evidence that fluoxetine may be useful in reducing comorbid psychopathology and enhancing maintenance in AN. However, there has been no placebo controlled study of fluoxetine in adolescent AN. Moreover, although there have been several small-scale studies of BFT there has been no controlled comparison with another form of family therapy. Hence, we propose to use systems family therapy (SFT) which has been developed and manualized to represent the type of family therapy practiced in the community. We propose to randomly allocate 240 adolescents aged 12-18 years with AN and their families to one of 4 groups: BFT + placebo; BFT + fluoxetine; SFT + placebo; and SFT + fluoxetine. Medication will be continued for 6-months beyond the end of family therapy to assess medication effects on the maintenance of therapeutic gains. Treatment and assessment will be carried out at 6 clinical sites with 40 subjects per site with separate data and coordinating centers. The treatment sites will follow common assessment and treatment protocols with detailed monitoring of recruitment, treatment, assessment and human subjects procedures by the coordinating center. The results of this study should provide guidance to clinicians concerning optimal treatment approaches for adolescent AN. From the public health perspective, development of effective treatments for adolescents will reduce the morbidity, mortality, and high costs associated with chronic AN.