目的:尽管最近的一些文章描述了患有难治性神经性厌食症(TR-AN)的成年人,没有研究涉及发育年龄对治疗无反应的受试者的具体特征。这项研究报告了临床和精神病理学变量,这些变量将对治疗无反应的儿童和青少年(此处为“TR-AN”)与良好结果对照区分开来。在多学科医院治疗环境中。
方法:自然主义,病例对照研究对治疗缺乏反应和良好结果控制的个体进行。TR-AN被定义为两个或两个以上不完整的录取和没有完整的录取,与成人研究一致。良好的结果被定义为完整的第一次入院,6个月后可进行随访,并且在过去3个月没有暴饮暴食或吹扫的情况下,在随访时保持%BMI>70%。精神病理学(饮食失调量表-3EDI-3;贝克抑郁量表-II),临床,并比较了入院时的治疗变量.探索性二元逻辑回归包括单变量分析中的显着差异。
结果:76名患者(30名TR-AN,纳入46名预后良好的AN对照)(平均年龄14.9±1.9岁,F=94.7%)。TR-AN个体的入院年龄较高,EDI-3饮食障碍风险(EDRC)得分较高,用鼻胃管(NGT)治疗频率较低,出院时的BMI改善低于结果良好的对照组。找到了TR-AN状态的预测模型(X2=19.116;Nagelkerke-R2=0.478,p<0.001),和入院年龄(OR=0.460,p=0.019),EDI-3EDRC(OR=0.938,p=0.043),NGT(OR=8.003,p=0.019)与TR-AN状态相关。
结论:这是关于对治疗无反应的儿童和青少年的精神病理学和临床特征的第一份报告。这些患者表现出更高的年龄和饮食失调评分,与对照组相比,服用NGT的频率较低。尽管我们的科目多次不完整录取,短纳入随访限制了与治疗耐药患者的成人样本进行直接比较的可能性.因此,应在纵向研究中评估TR-AN儿童和青少年的具体特征.
方法:III,观察,病例对照研究。
OBJECTIVE: Although a few recent articles describe adults with treatment-resistant anorexia nervosa (TR-AN), no study addresses the specific features of subjects not responding to treatment in the developmental age. This study
reports on the clinical and psychopathological variables that distinguish children and adolescents who did not respond to treatment (here \"TR-AN\") from good-outcome controls, in a multidisciplinary hospital treatment setting.
METHODS: Naturalistic,
case-control study conducted on individuals showing lack of response to treatment and good-outcome controls. TR-AN was defined as two or more incomplete admissions and no complete admissions, consistently with studies in adults. Good-outcome was defined as complete first admission, availability for follow-up visit after 6 months, and maintaining at follow-up a %BMI > 70% in the absence of binging or purging in the preceding 3 months. Psychopathological (Eating Disorders Inventory-3 EDI-3; Beck Depression Inventory-II), clinical, and treatment variables at admission were compared. Significant differences in the univariate analyses were included in an exploratory binary logistic regression.
RESULTS: Seventy-six patients (30 TR-AN, 46 good-outcome AN controls) were enrolled (mean age 14.9 ± 1.9 years, F = 94.7%). TR-AN individuals had a higher age at admission and higher EDI-3 Eating Disorder Risk (EDRC) scores, were treated less frequently with a nasogastric tube (NGT), and achieved a lower BMI improvement at discharge than good-outcome controls. A predictive model for TR-AN status was found (X2 = 19.116; Nagelkerke-R2 = 0.478, p < 0.001), and age at admission (OR = 0.460, p = 0.019), EDI-3 EDRC (OR = 0.938, p = 0.043), and NGT (OR = 8.003, p = 0.019) were associated with a TR-AN status.
CONCLUSIONS: This is the first report on the psychopathological and clinical characteristics of children and adolescents not responding to treatment. These patients showed higher age and eating disorder scores, and were less frequently fed with NGT than controls. Despite the multiple incomplete admissions of our subjects, the short included follow-up limits the possibility for direct comparisons with adult samples of treatment-resistant patients. Thus, the specific features of children and adolescents with TR-AN should be assessed in longitudinal studies.
METHODS: III, Observational,
case-control study.