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，与严重的精神和医学发病率和死亡率以及由于使用强化治疗而导致的高昂治疗费用有关。有证据表明，对于青少年AN，无论是在治疗结束时还是在4-5年的随访中，FBT都是一种有效的门诊治疗方法。使用FBT，在12个月的随访中，大约50%的参与者缓解(平均为%IBW&>95+EDE&>1SD)，90%的患者在治疗后完全缓解。相比之下，在治疗后未完全缓解的患者中，75%在后续治疗中仍未缓解。由于目前尚无对成人AN的有效治疗方法，而且患有AN的青少年似乎对治疗更敏感，因此努力改善这一年龄段的结果对于防止慢性和持续病程的发展至关重要。然而，当对FBT的反应不充分时，通常建议进行更密集的程序化治疗(例如日间治疗、住院护理或精神科住院治疗)。尽管此类计划普遍使用，但现有数据并未表明这些干预措施在青少年中比门诊干预更有效。对于那些对FBT没有反应的人来说，改善结果的另一种战略是直接向家庭本身提供额外的和有针对性的门诊帮助。数据表明，FBT不太可能成功的家庭最早可以在治疗后一个月被发现。因此，在治疗过程中及早提供替代疗法可能会提高整体疗效。为了开发一种新的强化家庭治疗(IFT)以改善那些对FBT没有早期反应的人的预后，我们提出了一项两阶段治疗开发研究，其目的是(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)，针对不利于的行为并促进有帮助的行为(阶段1-迭代病例系列(n=40))，以及(3)在小型随机对照试验中试点IFT(针对那些对FBT没有早期反应的人)和单独的FBT，以及(4)探索家庭和个人因素作为预测、调节、和治疗介体(阶段2-小型随机对照试验(n=50))。为了实现这些目标，这项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(芝加哥大学45名参与者，斯坦福大学45名参与者)。主要结果将是完全缓解(平均%IBW&>95+EDE&>1SD)。将在基线和治疗结束时评估主要结果以及潜在的预测因素、主持人和调解人，并将包括父母和孩子的与饮食有关的精神病理学(进食障碍检查)、耶鲁-布朗-康奈尔-进食障碍、身高/体重、父母和孩子的一般精神病理学、家庭状况和家庭功能。 公共卫生相关性：与任何其他精神疾病相比，神经性厌食症(AN)的死亡率最高。对患有AN的青少年最有希望的治疗方法是基于家庭的治疗(FBT)。然而，接受FBT治疗的患者中，只有50%在12个月的随访中完全缓解。因此，对于那些对FBT无效的患者，在治疗过程中及早提供替代疗法可能会提高整体疗效。这项研究旨在开发一种新的强化治疗--以家庭为重点的治疗(IFT)--以改善那些12-18岁对FBT没有早期反应的青少年的结果。

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.