Anorexia Nervosa: The Importance of Treatment Intensity

描述（由申请人提供）：该R34探索性研究补助金的目的是开始获得关于神经性厌食症（AN）治疗的急需的对照数据。AN是一种严重的疾病，与大量的发病率和死亡率相关。近年来，由于经济压力限制了医院治疗，治疗发生了重大变化，并且没有关于这些变化影响的严格数据。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，没有基于证据的建议。本申请提出了一项关于AN患者体重恢复的两种治疗方法的小型随机试验。延长住院体重恢复治疗将被比作一个“真实的世界”的治疗，主要包括一个密集的门诊方法。该项目的最初六个月将用于开发和操作这两种治疗方法。住院治疗将基于纽约州精神病研究所提供的治疗，这是一家州政府支持的研究医院。“真实的世界”治疗将基于约翰霍普金斯医疗机构备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，然后是一段时间的日间计划治疗，主要由健康保险计划报销。将对霍普金斯模型进行调整，以便在NYSPI进行手动化和治疗。两家管理式医疗公司的代表将参与研究治疗开发，以确保该项目与“真实的世界”实践和报销一致。这可能是一个有时间限制的，有序的治疗，将是治疗强度低于医院计划。在该项目的最后2.5年，将在纽约州立精神病研究所进行一项关于住院患者体重恢复和强度较低的“真实的世界”治疗模型的小型随机比较试验。将在随机化后18个月内收集随访信息。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。

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.