Longitudinal Follow-up of Purging Syndromes: Outcome and Predictors

净化综合征的纵向随访：结果和预测因素

• 批准号: 8907197
• 负责人: Katherine Jean Forney
• 金额: $ 3.54万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8907197
• 关键词: Affective; Behavioral; Binge Eating; Biological; Biological Assay; Biological Factors; Bulimia; Cholecystokinin; Clinical; Clinical Sciences; Cognitive; Communities; Data; Diagnosis; Diagnostic; Diagnostic and Statistical Manual of Mental Disorders; Dimensions; Disease; Disease remission; Diuretics; Eating; Eating Disorders; Ethics; Evidence based treatment; Food; Frequencies; Funding; Future; Genetic Crossing Over; Grant; Health; Hormonal; Hormones; Impairment; Individual; Individual Differences; Instruction; International Classification of Diseases; Intervention; Interview; Lead; Leptin; Link; Longitudinal Studies; Maintenance; Mentorship; Minority; Modeling; National Institute of Mental Health; National Research Service Awards; Neurosciences; Outcome; Participant; Patient Self-Report; Physiological; Physiology; Psychological Factors; Quality of life; Questionnaires; Recruitment Activity; Relapse; Research; Research Project Grants; Research Training; Risk; Rotation; Sampling; Satiation; Severities; Shapes; Statistical Methods; Syndrome; Testing; Time; Training; Training Programs; Translational Research; Treatment outcome; Vomiting; Weight; Woman; Writing; base; career; disability; disorder risk; follow-up; improved; laxative; loss of control over eating; mortality; novel; programs; psychologic; public health relevance; purge; purging behavior; purging disorder; response; self reported behavior; suicidal risk; therapy development

 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.

 描述（由申请人提供）：泻下综合征（PS），包括泻下障碍（PD）和神经性贪食症（BN），是以泻下为特征的进食障碍，与严重的健康并发症、残疾和自杀风险/死亡率增加相关。虽然数据支持PD和BN作为单独综合征的并发有效性，但描述PD结局的纵向数据有限，无法支持这种区分的预测有效性。如果结果和 如果PD和BN的预后预测因子不同，则PD应作为单独的诊断添加到DSM的未来版本中。如果PD和BN在结局或结局预测因素方面没有差异，则BN的定义应扩展至包括PD。缺乏证据为基础的治疗PD和治疗效果差的BN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，更好的理解需要在饮食失调维持模型中整合心理和生物因素。Ruth L. Kirschstein国家研究服务奖（NRSA）是一项为期30个月的培训和研究计划，专注于转化临床神经科学，将为申请人从事研究事业做好准备，致力于了解饮食失调的风险和维持因素。除了完成申请人博士课程的要求外，拟议的培训计划将通过神经科学课程的研究生培训，实验室轮换和激素测定指导，统计方法，伦理学和赠款写作的高级培训以及统计指导来通知拟议的纵向研究。将从两项先前的NIMH资助的研究中招募219名妇女（88名PD; 131名BN）的社区样本。将邀请参与者在初始评估后平均（SD）10.89（3.21）年完成评估。具体目的是1）检查PD和BN之间区别的预测有效性，2）评价PS结局的认知、认知情感、行为和生理预测因子，以告知未来的治疗开发，3）评价探索性分析中PD和BN之间的结局预测因子（目的2）是否不同。对于目标1，申请人假设PD与BN相比结局更好，并且疾病之间的诊断差异将证明纵向稳定性。对于目标2，申请人预测，更严重的形状问题（自我报告的认知因素）、更频繁的饮食失控（自我报告的认知-情感因素）、更大的饮食发作规模（行为因素）、低瘦素浓度（生理因素）和钝化的餐后胆囊收缩素反应（生理因素）将与更差的结果相关。本研究将为PD和BN的概念化提供信息，并可能确定多个干预机会点。完成拟议的培训计划和研究将准备申请人进行必要的尖端转化研究，以提高对饮食失调的理解和治疗。