Longitudinal Follow-up of Purging Syndromes: Outcome and Predictors

 描述(申请人提供)：通便综合症(PS)，包括通便障碍(PD)和神经性暴食症(BN)，是以通便为标志的饮食障碍，与严重的健康并发症、残疾和增加的自杀风险/死亡率有关。虽然数据支持PD和BN作为独立综合征的同时有效性，但有限的纵向数据描述了PD的结果，以支持这一区别的预测有效性。如果结果和 PD和BN对预后的预测因素不同，因此在未来的DSM版本中应将PD作为单独的诊断添加。如果PD和BN在结果或预测结果方面没有不同，那么BN的定义应该扩展到包括PD。缺乏对帕金森病的循证治疗，以及BN的治疗结果不佳，表明需要更好地了解结果的预测因素，以开发更有效的治疗方法。重要的是，更好的理解需要在进食障碍维持模型中整合心理和生物因素。建议的Ruth L.Kirschstein国家研究服务奖(NRSA)是一个为期30个月的培训和研究计划，专注于翻译临床神经科学，为申请者从事致力于了解饮食失调的风险和维持因素的研究生涯做好准备。除了完成申请者博士课程的要求外，拟议的培训计划还将通过神经科学课程的研究生培训、实验室轮换和荷尔蒙分析指导、统计方法、伦理和拨款撰写的高级培训以及统计指导，为拟议的纵向研究提供信息。将从NIMH资助的两项研究中招募219名妇女(88名PD；131名BN)的社区样本。参与者将被邀请在初次评估后的平均10.89(3.21)年内完成评估。具体目的是1)检验PD和BN之间区别的预测有效性，2)评估PS结果的认知、认知-情感、行为和生理预测因素，以便为未来的治疗发展提供信息，以及3)在探索性分析中评估PD和BN之间的结果预测因素(目标2)是否不同。对于目标1，申请人假设与BN相比，PD将与更好的结局相关，并且疾病之间的诊断区别将证明纵向稳定性。对于目标2，申请人预测，更严重的形状担忧(自我报告的认知因素)，更频繁的失控进食(自我报告的认知-情感因素)，更大的进食发作规模(一种行为因素)，较低的瘦素浓度(一种生理因素)，以及迟钝的餐后缩胆囊素反应(一种生理因素)将与较差的结果相关。这项研究将为PD和BN的概念化提供信息，并可能确定多个干预机会。完成拟议的培训计划和研究将使申请者做好准备，进行必要的尖端翻译研究，以提高对饮食失调的理解和治疗。

 DESCRIPTION (provided by applicant): Purging syndromes (PS), including Purging Disorder (PD) and Bulimia Nervosa (BN), are eating disorders marked by purging and associated with severe health complications, disability, and increased suicide risk/mortality. While data support the concurrent validity of PD and BN as separate syndromes, limited longitudinal data exist describing the outcome of PD to support the predictive validity of this distinction. If outcome and predictors of outcome differ between PD and BN, then PD should be added as a separate diagnosis in future editions of the DSM. If PD and BN do not differ in outcome or predictors of outcome, then BN's definition should be expanded to include PD. Lack of evidence-based treatments for PD and poor treatment outcomes in BN suggest that a better understanding of predictors of outcome is needed to develop more efficacious treatments. Importantly, an improved understanding requires integration of psychological and biological factors in models of eating disorder maintenance. The proposed Ruth L. Kirschstein National Research Service Award (NRSA) is a thirty-month program of training and research focused on translational clinical neuroscience that will prepare the applicant to pursue a research career dedicated to understanding risk and maintenance factors for eating disorders. In addition to completing requirements of the applicant's doctoral program, the proposed training program will inform the proposed longitudinal study through graduate training in neuroscience coursework, a lab rotation, and instruction in hormonal assays, advanced training in statistical methods, ethics, and grant-writing, and statistical mentorship. A community-based sample of 219 women (88 PD; 131 BN) will be recruited from two prior NIMH funded studies. Participants will be invited to complete assessments a mean (SD) of 10.89 (3.21) years after initial assessments. The specific aims are to 1) examine the predictive validity of the distinction between PD and BN, 2) evaluate cognitive, cognitive-affective, behavioral, and physiological predictors of PS outcome in order to inform future treatment development, and 3) evaluate if predictors of outcome (Aim 2) differ between PD and BN in exploratory analyses. For Aim 1, the applicant hypothesizes that PD will be associated with better outcome compared to BN and diagnostic distinctions between disorders will demonstrate longitudinal stability. For Aim 2, the applicant predicts that more severe shape concerns (a self-reported cognitive factor), more frequent loss of control eating (a self- reported cognitive-affective factor), greater eating episode size (a behavioral factor), lowe leptin concentrations (a physiological factor), and blunted postprandial cholecystokinin response (a physiological factor) will be associated with worse outcome. This study will inform the conceptualization of PD and BN and may identify multiple points of opportunity for intervention. Completing the proposed training program and research will prepare the applicant to conduct cutting-edge translational research necessary to improve the understanding and treatment of eating disorders.