2/2-Treatment of Adolescent Bulimics

描述(申请人提供)：神经性暴食症(BN)是一种严重的疾病，其特征是对体重和体型的看法被高估，饮食模式不受限制，包括极端节食、暴饮暴食和排泄。BN发生在大约1%-2%的青少年人口中，而临床上显著的暴食症行为或部分BN(具体定义为在六个月内平均每周至少暴食一次和排泄)发生在另外2%-3%。然而，除了暴饮暴食和通便行为的频率外，BN完全综合征和部分性BN患者的临床严重程度似乎没有什么不同。虽然暴食症行为通常在青春期开始，但只有两项已发表的随机临床试验(RCT)检验了这一年龄段的治疗方法。我们最近发表的使用家庭治疗形式的青少年BN随机对照试验(FBT-BN)的结果表明，FBT-BN对青少年BN的治疗优于个人治疗。此外，最近发表的病例系列报告表明，针对青少年调整的CBT-A是这个年龄段的暴食症的一种有前途的治疗方法。该提案的具体目的是：目标1：比较CBT-A和FBT-BN在减少患有BN和部分BN(定义为在过去六个月内每周至少暴食一次)青少年暴食和通便发作方面的疗效。我们预测，与接受FBT-BN的受试者相比，随机接受CBT-A的受试者实现禁欲的比率(通过饮食紊乱检查进行评估)将显著高于那些接受CBT-A的受试者。目标2：探索潜在的结果调节因素。我们预测，基线时的症状严重程度将缓和结果；具体地说，那些症状严重程度较高(EDE子量表得分较高)的受试者，CBT-A的结果将好于FBT-BN。目标3：探索影响结果的潜在中介因素。我们预测，EDE-Q的约束子量表的早期变化将在两种治疗中起到调节作用。目的4：如果两种特定疗法之间没有差异，我们将探索特定疗法(CBT-A和FBT-BN)与非特定疗法(支持性心理疗法-SPT)之间的戒断差异，以检验非特定疗法的效果(时间推移和非特异性治疗影响)。为了实现这些目标，建议进行以下两个地点的研究：158名12-18岁的青少年(每个地点79人)符合BN或部分BN的DSM-IV标准，将被随机分为CBT-A组(66名受试者)、FBT-BN组(66名受试者)或SPT(26名受试者)，这是一种治疗BN的非特异性治疗方法，为期20个疗程/6个月。这项研究的主要目的是分析比较两种特定治疗(FBT-BN和CBT-A)的主要目的；然而，我们正在随机选择SPT的较小队列，以便在两种特定治疗之间没有发现差异的情况下，对非特定治疗因素进行特殊检查。

DESCRIPTION (provided by applicant): Bulimia Nervosa (BN) is a serious disorder characterized by overvalued ideas concerning body weight and shape and disinhibited eating patterns consisting of extreme dieting followed by binge eating and purging. BN occurs in approximately 1-2% of the adolescent population, while clinically significant bulimic behaviors or partial BN (specifically defined as binge eating and purging on average at least once a week for six months) occur in an additional 2-3%. However, other than frequency of binge eating and purging behaviors there appear to be few differences in the clinical severity of those with full syndrome BN and those with partial BN. Although bulimic behaviors typically onset during adolescence, there are only two published randomized clinical trials (RCTs) examining treatments for this age group. Results from our own recently published RCT of adolescent BN using a form of family-based therapy (FBT-BN) has shown that FBT-BN is superior to individual therapy for adolescents with BN. Also, recently published case series reports suggest that CBT adjusted for adolescents (CBT-A) is a promising treatment for bulimia in this age group. The Specific Aims of the proposal are: Aim 1: To compare the efficacy of CBT-A to FBT-BN in decreasing binge eating and purging episodes in adolescents with BN and partial BN (defined as binge eating and purging at least one time per week for the past six months). We predict that subjects randomized to CBT-A will achieve abstinence (as assessed by the Eating Disorder Examination) at significantly higher rates than those who receive FBT- BN. Aim 2: To explore potential moderators of outcome. We predict that symptom severity at baseline will moderate outcome; specifically, those subjects with greater symptom severity (higher EDE subscale scores) will have better outcomes with CBT-A than FBT-BN. Aim 3: To explore potential mediators of outcome. We predict that early changes in the restraint subscale of the EDE-Q) will mediate outcome in both treatments. Aim 4: If there are no differences between the two specific treatments, we will explore abstinence differences between specific treatments (CBT-A and FBT-BN) compared to a non-specific treatment (Supportive Psychotherapy - SPT) in order to examine nonspecific treatment effects (passage of time and nonspecific therapeutic influences). To accomplish these aims the following two-site study is proposed: 158 adolescents (79 at each site) between the ages of 12-18 years who meet DSM- IV criteria for BN or partial BN will be randomized to CBT-A (66 subjects), FBT-BN (66 subjects) or SPT (26 subjects), a non-specific treatment for BN for a 20 session/six month treatment period. The study is powered for the analysis of the primary aim of comparing the two specific treatments (FBT-BN and CBT-A); however, we are randomizing a smaller cohort to SPT to allow a post-hoc examination of non-specific treatment factors should no differences be found between the two specific treatments.