2/2-Treatment of Adolescent Bulimics

2/2-青少年贪食症的治疗

• 批准号: 7686224
• 负责人: DANIEL LE GRANGE
• 金额: $ 26.18万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-12 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7686224
• 关键词: Abstinence; Address; Adolescence; Adolescent; Adult; Aftercare; Age; Anorexia Nervosa; Anxiety Disorders; Arrhythmia; Behavior; Binge Eating; Body Weight; Bulimia; Case Series; Cessation of life; Clinical; Clinical Treatment; Cognition; DSM-IV; Data; Dehydration; Diagnostic and Statistical Manual; Diet; Disease; Eating; Eating Disorders; Esophageal; Family; Family psychotherapy; Frequencies; Hand; Hypokalemia; Individual; Literature; Mediating; Mediator of activation protein; Orthostasis; Outcome; Patient Self-Report; Pattern; Personality Disorders; Population; Psychopathology; Psychotherapy; Publishing; Randomized; Randomized Clinical Trials; Reporting; Research; Self Care; Severities; Shapes; Site; Stomach; Substance abuse problem; Sum; Supportive care; Symptoms; Syndrome; Therapeutic; Time; Treatment Factor; active method; age group; base; behavior change; clinically significant; cognitive behavior therapy; cohort; comparative efficacy; cost; depression; effective therapy; meetings; neglect; primary outcome; purge; purging behavior; restraint; secondary outcome; treatment duration; treatment effect; trial comparing

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.

描述（由申请人提供）：神经性贪食症（BN）是一种严重的疾病，其特征是关于体重和形状的高估想法，以及由极端饮食组成，然后是暴饮暴食和清除。 BN发生在大约1-2％的青少年人口中，而临床上显着的泡沫行为或部分BN（特异性定义为每周至少每周至少每周至少一次清除六个月）的额外2-3％。但是，除了暴饮暴食和清除行为的频率外，完全综合征BN的临床严重程度和部分BN的临床严重程度差异很小。尽管大胆的行为通常在青春期发作，但只有两项已发表的随机临床试验（RCT）检查该年龄段的治疗方法。使用基于家庭的治疗形式（FBT-BN），我们自己最近发表的青少年BN RCT的结果表明，FBT-BN对BN的青少年优越。此外，最近发表的病例系列报告表明，针对青少年调整的CBT（CBT-A）是该年龄段的贪食症的一种有希望的治疗方法。该提案的具体目的是：目标1：比较CBT-A对FBT-BN的疗效，以减少BN和部分BN的青少年的暴饮暴食和清除发作（在过去六个月中，至少每周至少每周一次饮食饮食和清除）。我们预测，随机分配给CBT-A的受试者将以比接受FBT-bn的人的戒酒（通过饮食失调检查评估）。目标2：探索结果的潜在主持人。我们预测基线时的症状严重程度将适度。具体而言，那些具有更大症状严重程度的受试者（EDE量表分数较高）将与FBT-BN相比，CBT-A的结果更好。目标3：探索潜在的结果介体。我们预测，EDE-Q的约束量表的早期变化将介导两种治疗的结果。目标4：如果两种特定治疗方法之间没有差异，我们将探索特定治疗方法（CBT-A和FBT-BN）之间的禁欲差异，与非特异性治疗（支持性心理治疗-SPT）相比，以检查非特异性治疗效果（通过时间和非特异性治疗效果）。为了实现这些目的，提出了以下两个站点的研究：在12-18岁之间，符合BN或部分BN的DSM-IV标准的158名青少年（在每个地点为79个）将被随机分配给CBT-A（66名受试者），FBT-BN（66个受试者（66个受试者）（26个受试者）或六个月的治疗时间，请接受bn non-pectecip for bn。该研究用于分析比较两种特定治疗方法（FBT-BN和CBT-A）的主要目的。但是，我们正在将较小的队列随机与SPT进行，以便在两种特定治疗方法之间没有发现差异后进行事后检查。