Anorexia Nervosa: The Importance of Treatment Intensity

描述(由申请人提供)：这项R34探索性研究资助的目的是开始获得关于神经性厌食症(AN)治疗方面亟需的对照数据。AN是一种严重的疾病，与大量的发病率和死亡率有关。近年来，由于经济压力限制了以医院为基础的治疗，治疗方法发生了显着变化，关于这些变化的影响，没有严格的数据。事实上，对于这种具有挑战性的疾病的治疗的基本组成部分，没有循证的建议。这项申请提出了一项关于两种治疗AN患者体重恢复的小规模随机试验。延长住院患者的体重恢复治疗将与主要包括强化门诊治疗在内的“真实世界”治疗相比较。该项目的最初六个月将用于制定两种治疗方法并将其付诸实施。住院治疗将基于纽约州精神病研究所提供的治疗，纽约州精神病学研究所是一家由州政府支持的研究型医院。“现实世界”的治疗将基于约翰·霍普金斯医疗机构广受好评和成功的治疗计划。霍普金斯计划包括较短的住院时间，然后是一段时间的计划治疗，主要由医疗保险计划报销。将对霍普金斯模式进行调整，以便在NYSPI实现治疗的程序化和实施。来自两家管理型护理公司的代表将参与这项研究治疗的开发，以确保该计划与“现实世界”的实践和报销一致。这可能是一种有时间限制的顺序治疗，与医院计划相比，治疗强度较低。在该项目的最后两年半，将在纽约州精神病学研究所进行一项住院患者体重恢复的小型随机对照试验和一种强度较低的“真实世界”治疗模式。将在随机化后的18个月内收集后续信息。结果测量将包括体重、饮食行为和相关的精神病理学，以及研究期间的服务利用情况。

DESCRIPTION (provided by applicant): The aim of this R34 Exploratory Research Grant is to begin to obtain much needed controlled data regarding the treatment of anorexia nervosa (AN). AN is a serious disorder and is associated with substantial morbidity and mortality. Treatment has changed significantly in recent years due to economic pressures that have limited hospital-based treatments and there are no rigorous data regarding the impact of these changes. In fact, there are no evidence-based recommendations regarding the essential components of treatment for this challenging disorder. This application proposes a small randomized trial of two treatments for weight restoration in patients with AN. Extended inpatient weight-restoration treatment will be compared to a "real world" treatment that includes primarily an intensive outpatient approach. The initial six months of the project will be used to develop and manualize the two treatment approaches. The inpatient treatment will be based on the treatment offered by The New York State Psychiatric Institute, a state-supported research hospital. The "real world" treatment will be based on the well regarded and successful treatment program at Johns Hopkins Medical Institution. The Hopkins program consists of a shorter inpatient stay followed by a period of day program treatment, reimbursed primarily by health insurance plans. The Hopkins model will be adapted for the purposes of manualization and execution of the treatment at NYSPI. Representatives from two managed care companies will participate in the study treatment development in order to assure that the program is consistent with "real world" practice and reimbursement. It will likely be a time-limited, sequenced treatment that will be less treatment-intensive than will the hospital program. In the final 2.5 years of the project, a small randomized comparison trial of inpatient weight restoration and a less intensive model of "real world" treatment will be conducted at The New York State Psychiatric Institute. Follow-up information will be collected over an 18-month period following randomization. Outcome measures will include weight, eating behaviors and associated psychopathology, as well as service utilization during the study period.