■Binge谱系障碍在世界范围内普遍存在。精神病和医学合并症很常见,社会成本是巨大的。循证治疗仍未得到充分利用。认知行为疗法是推荐的一线治疗方法,但是药物治疗可能更容易获得。
■缺乏直接比较认知行为疗法与药物疗法的Meta分析证据。我们旨在比较认知行为疗法干预与任何药物治疗对暴饮暴食谱系障碍的影响。我们搜索了PubMed,Embase,中部,ClinicalTrials.gov和随机对照试验的参考列表,比较认知行为疗法与任何药物疗法治疗神经性暴食症/暴饮暴食症,并进行成对荟萃分析评估。
■主要结果是缓解和发作频率。次要结果是清洗的频率,回应,进食障碍精神病理学,体重/体重指数,抑郁症,焦虑,生活质量和辍学。
■确定了11项比较认知行为疗法与氟西汀/丙咪嗪/地昔帕明/哌醋甲酯/西布曲明的随机对照试验(N=531)。认知行为疗法在缓解方面优于抗抑郁药,暴饮暴食和进食障碍精神病理学的频率。在反应/抑郁/焦虑/体重/生活质量/辍学方面,任何个体认知行为疗法与药物比较均无统计学差异。认知行为疗法在主要结局方面并不优于西布曲明/哌醋甲酯。
■数据很少,比较能力不足,考虑到心理治疗试验固有的方法学局限性,出现了关于认知行为疗法的假定优越性的问题。需要进一步的研究。
UNASSIGNED: Binge spectrum disorders are prevalent worldwide. Psychiatric and medical comorbidities are common, and societal costs are significant. Evidence-based treatment remains underutilized. Cognitive behavioral therapy is the recommended first-line treatment, but pharmacotherapy may be easier to access.
UNASSIGNED: Meta-analytic evidence directly comparing cognitive behavioral therapy with pharmacotherapy is lacking. We aimed to compare the effects of cognitive behavioral therapy interventions with any pharmacological treatment for binge spectrum disorders. We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov and reference lists for randomized controlled trials comparing cognitive behavioral therapy with any pharmacotherapy for bulimia nervosa/binge eating disorder and performed pairwise meta-analytic evaluations.
UNASSIGNED: Primary outcomes are remission and frequency of binges. Secondary outcomes are frequency of purges, response, eating disorder psychopathology, weight/body mass index, depression, anxiety, quality of life and dropouts.
UNASSIGNED: Eleven randomized controlled trials comparing cognitive behavioral therapy with fluoxetine/imipramine/desipramine/methylphenidate/sibutramine were identified (N = 531). Cognitive behavioral therapy was superior to antidepressants in terms of remission, frequency of binges and eating disorder psychopathology. There were no statistically significant differences for any of the individual cognitive behavioral therapy vs drug comparisons in terms of response/depression/anxiety/weight/quality of life/dropouts. Cognitive behavioral therapy was not superior to sibutramine/methylphenidate for the primary outcomes.
UNASSIGNED: Data are scarce, comparisons underpowered and, considering the inherent methodological limitations of psychotherapy trials, questions arise regarding the presumed superiority of cognitive behavioral therapy. Further research is needed.