1/2-Adaptive Family Treatment for Adolescent Anorexia

1/2-青少年厌食症适应性家庭治疗

• 批准号: 8470244
• 负责人: DANIEL LE GRANGE
• 金额: $ 5.04万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2014-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8470244
• 关键词: Adolescent; Adult; Aftercare; Alternative Therapies; Amenorrhea; Anorexia; Anorexia Nervosa; Behavior; Belief; Body Weight decreased; Caring; Case Series; Chicago; Child; Chronic; Clinical; Cognition; DSM-IV; Data; Data Coordinating Center; Development; Disease; Disease remission; Eating; Eating Disorders; Elements; Evidence based treatment; Family; Funding; Grant; Height; Hospitalization; Individual; Intervention; Link; Manuals; Mediator of activation protein; Medical; Mental disorders; Morbidity - disease rate; Moths; Outcome; Outpatients; Parents; Participant; Patients; Phase; Pilot Projects; Process; Psychopathology; Questionnaires; Randomized; Recruitment Activity; Research; Research Design; Residential Treatment; Site; Supervision; Training; Treatment Cost; Universities; Videotape; Weight; Weight Gain; age group; aged; base; comparative; data management; design; effective therapy; experience; follow-up; improved; innovation; mortality; prevent; primary outcome; programs; response; restoration; therapy development; treatment duration; treatment program

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.

描述（由申请人提供）：神经性厌食症（AN）是一种严重的疾病，与大量的精神病和医疗发病率，死亡率以及由于使用强化治疗而导致的高治疗费用。有证据表明，青少年A的FBT在治疗结束时和4 - 5年随访时都是有效的门诊治疗。使用FBT，约有50％的参与者汇款（％IBW> 95 + EDE> 1SD的平均值）和90％的参与者在治疗后充分汇出的参与者汇款，在12个月后的随访中仍保持下降。相比之下，在治疗后未完全汇出的人中有75％在随访时仍未汇出。由于对患有AN的成年人和具有对治疗的反应更敏感的青少年没有已知的有效治疗方法，因此改善该年龄段的结果的努力对于防止慢性且不舒服的过程的发展至关重要。但是，当对FBT的反应不足时，通常建议使用更密集的程序治疗（例如日常治疗，住院护理或精神病住院）。尽管使用了此类程序，但可用的数据并未表明这些干预措施比青少年的门诊干预措施更有效。改善对FBT不反应的人的结果的另一种策略是，直接为家庭自己提供其他有针对性的门诊帮助。数据表明，最早可以在治疗后一个月内确定不太可能在FBT中取得成功的家庭。因此，在治疗课程的早期提供替代疗法可能会提高整体结果。为了开发一种新的治疗方法 - 以家庭为重点的治疗（IFT），以改善那些不显示早期反应的人的结果，我们提出了一项2阶段治疗开发研究，旨在（1）确定可修改的家庭因素/行为，这些因素/行为/行为/行为与完成重量恢复有关（3）IFT（对于不早于FBT响应的人）与FBT相比，在小的RCT中与FBT相比，（4）作为治疗的预测因素，主持人和介体（第2阶段 - 小RCT（n = 50））探索家族性和个体因素。为了实现这些目标，本研究将在两个地点（芝加哥大学的45名参与者，斯坦福大学的45名参与者）招募90名青少年（DSM-IV，不包括闭经）。主要结果将是从平均值的（％IBW> 95 + EDE> 1SD）中完全缓解。评估主要结果以及潜在的预测因素，主持人和介体将在基线和治疗结束时进行，包括父母和儿童中的相关心理病理学（饮食失调检查），耶鲁 - 棕色 - 肉眼饮食障碍，身高/体重，父母，儿童，家庭状况，家庭状况以及家庭状况以及家庭状况和家庭功能。