2/2-Treatment of Adolescent Bulimics

摘要 神经性贪食症（BN）是一种严重的疾病，其特征是对身体的过度重视 体重和形状以及由极端节食组成的无节制饮食模式， 暴饮暴食和排泄BN发生在大约1-2%的青少年人口中，而 临床上显著的贪食行为或部分BN（具体定义为暴饮暴食， 平均每周至少清洗一次，持续六个月）发生在另外的2- 3%。然而，在这方面， 除了暴饮暴食和排泄行为的频率外， 完全综合征BN和部分BN患者的临床严重程度。虽然贪食症 行为通常在青春期发作，只有两个已发表的随机临床 随机对照试验（RCT）检查该年龄组的治疗。结果从我们自己最近发表的 青少年BN的随机对照试验（RCT）使用一种形式的家庭为基础的治疗（FBT-BN）表明，BN是 上级优于BN青少年个体化治疗。此外，最近发表的案例系列 有报告表明，青少年CBT调整（CBT-A）是一种有前途的治疗贪食症 在这个年龄组。该提案的具体目的是：目的1：比较 CBT-A到FBT-BN在减少BN青少年的暴饮暴食和腹泻发作中的作用， 部分BN（定义为在过去六年中每周至少一次暴饮暴食和腹泻） 月）。我们预测随机分配至CBT-A组的受试者将实现禁欲（根据评估结果 在饮食方面，饮食者比饮食者更容易患上肥胖症。 BN.目的2：探索潜在的结果调节因子。我们预测症状的严重程度 基线将中度结局;具体而言，症状严重程度较高的受试者 （更高的EDE子量表评分）将有更好的结果与CBT-A比FBT-BN。目标3： 探索潜在的结果中介。我们预测，早期的变化，在克制分量表 的EDE-Q）将介导两种治疗的结果。目标4：如果没有差异 在两种特定治疗之间，我们将探讨特定治疗之间的禁欲差异。 治疗（CBT-A和FBT-BN）与非特异性治疗（支持性 心理治疗（SPT），以检查非特异性治疗效果（时间推移和 非特异性治疗影响）。为了实现这些目标，以下两个地点的研究是 拟定：158名符合DSM要求的12-18岁青少年（每个研究中心79名）- BN或部分BN的IV标准将随机分配至CBT-A（66例受试者）、FBT-BN（66例受试者） 或SPT（26例受试者），BN的非特异性治疗，20次/6个月治疗 期本研究旨在分析比较两种特定的 治疗（FBT-BN和CBT-A）;然而，我们将一个较小的队列随机分配到SPT， 如果未发现差异，则对非特异性治疗因素进行事后检查 这两种特殊的治疗方法。项目叙述 这项申请是一项建议，进行一项随机对照试验， 青少年神经性贪食症的社会心理治疗为了实现这些目标， 建议进行以下两个中心的研究：158名青少年（每个中心79名），年龄在 12-18岁，符合DSM-IV BN或BN-EDNOS标准（暴饮暴食， 最低频率为每周1次，持续时间至少为 6个月）将随机分配至CBT-A（n=66）、基于家庭的治疗-BN （n=66），或支持性心理治疗（n=26）。

Abstract 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 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. Project Narrative This application is a proposal to conduct a randomized controlled trial of three psychosocial treatments for adolescent bulimia nervosa. 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 BN-EDNOS (binge eating and purging episodes of a minimum frequency of 1 time per week for a minimum duration of 6 months) will be randomized to either CBT-A (n=66), family-based treatment-BN (n=66), or supportive psychotherapy (n=26).