2/2-Adaptive Family Treatment for Adolescent Anorexia Nervosa

描述（由申请人提供）：神经性厌食症（AN）是一种严重的疾病，具有显著的精神病学和医学发病率和死亡率，并且由于使用强化治疗而导致治疗费用高。有证据表明，在治疗结束和4-5年随访时，FBT对青少年AN是一种有效的门诊治疗方法。使用FBT，大约50%的参与者缓解（%IBW bbb95 + EDE >sd的平均值），90%的患者在治疗后完全缓解，在12个月的随访中仍然如此。相比之下，75%在治疗后未完全缓解的患者在随访时仍未得到缓解。由于目前还没有针对成人AN的有效治疗方法，而青少年AN似乎对治疗更有反应，因此努力改善这一年龄组的预后对于预防慢性和持续病程的发展至关重要。然而，当对FBT的反应不足时，通常建议更强化的计划治疗（例如，日间治疗、寄宿护理或精神病院住院）。尽管这些项目被普遍使用，但现有数据并不表明这些干预措施在青少年中比门诊干预措施更有效。对于那些对FBT没有反应的患者，改善结果的另一种策略是直接向家庭提供额外的、有针对性的门诊帮助。数据表明，在FBT中不太可能成功的家庭可以在治疗后一个月就被识别出来。因此，在治疗过程的早期提供替代疗法可能会提高整体效果。为了开发一种新的治疗方法-以家庭为中心的强化治疗（IFT）来改善那些对FBT没有早期反应的人的结果，我们提出了一项两阶段的治疗发展研究，旨在(1)确定干扰完成体重恢复的可改变的家庭因素/行为，(2)开发一种新的家庭治疗（IFT）针对无益行为和促进有益行为（阶段1 -迭代病例系列（n=40））。(3)在一项小型随机对照试验中，试点IFT（针对那些对FBT没有早期反应的患者）与单独使用FBT，(4)探索家族和个人因素作为治疗的预测因素、调节因子和中介（第2期-小型随机对照试验（n=50））。为了实现这些目标，本研究将在两个地点招募90名患有AN （DSM-IV，不包括闭经）的青少年及其家人（45名参与者在芝加哥大学，45名参与者在斯坦福大学）。主要结局将是AN完全缓解（IBW % bbb95 + EDE % >sd）。主要结果的评估以及潜在的预测因素、调节因素和调节因素将在基线和治疗结束时进行，包括父母和孩子的饮食相关精神病理（饮食失调检查）、耶鲁-布朗-康奈尔-饮食失调、身高/体重、父母和孩子的一般精神病理、家庭状况和家庭功能。

DESCRIPTION (provided by applicant): Anorexia Nervosa (AN) is a serious disorder associated with significant psychiatric and medical morbidity and mortality and high treatment costs due to the use of intensive treatment. Evidence suggests that FBT for adolescent AN is an effective outpatient treatment both at the end of treatment and 4-5 year follow-up. Using FBT, about 50% of participants remit (%IBW>95 + EDE >1SD of the mean) and 90% of those fully remitted at post-treatment, remain so at 12-month follow-up. In contrast, 75% of those not fully remitted at post-treatment are still not remitted at follow-up. Because there are no known effective treatments for adults with AN, and adolescents with AN appear to be more responsive to treatment, efforts to improve outcomes in this age group are critical to prevent the development of a chronic and unremitting course. However, when response to FBT is inadequate, more intensive programmed treatment (e.g. day treatment, residential care, or psychiatric hospitalization) is often recommended. Despite the common use of such programs, available data do not suggest that these interventions are more effective than outpatient interventions in adolescents. An alternative strategy to improve outcomes for those that do not respond to FBT would be to provide additional and targeted outpatient help directly to families themselves. Data suggest that families that are not likely to be successful in FBT can be identified as early as one month into treatment. Consequently, providing an alternative therapy early in the treatment course may enhance overall outcome. To develop a new treatment - Intensive Family-Focused Treatment (IFT) to improve outcomes in those who do not show an early response to FBT we propose a 2-phase treatment development study which aims to (1) identify modifiable family factors/behaviors that interfere with accomplishing weight restoration, and (2) develop a new family treatment (IFT) targeting unhelpful behaviors and promoting helpful ones (Phase 1 - Iterative case series (n=40)), and (3) pilot IFT (for those not responding early to FBT) vs. FBT alone in a small RCT, and (4) explore familial and individual factors as predictors, moderators, and mediators of treatment (Phase 2 - Small RCT (n=50)). To achieve these aims, this study will recruit 90 adolescents with AN (DSM-IV, exclusive of amenorrhea) and their families at two sites (45 participants at The University of Chicago and 45 at Stanford University). Primary outcome will be full remission from AN (%IBW>95 + EDE >1SD of the mean). Assessment of primary outcome as well as potential predictors, moderators and mediators will occur at baseline and at the end of treatment and will include eating related psychopathology in the parent and child (Eating Disorder Examination), Yale- Brown-Cornell-Eating Disorder, height/weight, general psychopathology in parent and child, family status, and family functioning. PUBLIC HEALTH RELEVANCE: Anorexia Nervosa (AN) has the highest mortality rate compared to any other psychiatric disorder. The most promising treatment for adolescents with AN is family-based treatment (FBT). However, only 50% of patients receiving FBT fully remit at 12-moth follow-up. Consequently, providing an alternative therapy early in the treatment course for those not responding to FBT may enhance overall outcome. This study aims to develop a new treatment - Intensive Family-Focused Treatment (IFT) - to improve outcomes in those adolescents, aged 12-18 years, who do not show an early response to FBT.