背景:有新的证据表明,兴奋剂需要进一步研究作为神经性贪食症(BN)的治疗方法,包括最近的一项开放标签可行性试验,研究使用右旋氨氟胺(LDX)治疗BN。本报告介绍了可行性试验的次要结果和定性访谈结果。这些结果探索了几种所谓的机制,可以解释兴奋剂如何影响BN的症状:食欲,冲动,强迫性症状,饮食失调精神病理学/损害和基于奖励的决策。
方法:23名BN患者接受LDX治疗8周。问卷评估食欲,冲动,强迫性症状,在基线和治疗后对患者进行进食障碍心理病理学和损伤治疗.参与者还完成了两步强化学习任务,以评估他们的决策。半结构化访谈发生在基线,第5周,并随访。
结果:饥饿减少,与食物相关的冲动,强迫性和强迫性特征,发现了进食障碍的精神病理学和障碍。然而,奖励学习,就任务评估而言,似乎对LDX对BN症状的影响没有贡献。定性分析提出了四个主题:(1)缓解饮食失调,(2)功能和生活质量的改善,(3)恢复的新希望,和(4)使饮食正常化的能力。
结论:本报告提出了一些潜在的机制,通过这些机制,LDX可以减轻BN患者的剧痛和清除症状。重要的是,由于开放标签设计,我们无法将发现归因于药物。相反,我们的结果应该被解释为假设产生,从而为未来的研究提供信息,例如足够有效的随机对照试验.试验注册NCT03397446。
最近的研究表明,兴奋剂药物可能是神经性贪食症(BN)的潜在治疗方法。这项研究的参与者服用二甲磺酸盐(LDX)8周,同时仔细监测他们的饮食失调症状和医疗状况。作为这项研究的一部分,国阵的23名参与者完成了几次采访,在治疗开始和结束时进行的问卷调查和计算机任务,以帮助研究人员更多地了解LDX如何影响BN患者。随着时间的推移,测量饮食失调不同方面的问卷得分有所改善。在治疗过程中,参与者在衡量决策类型的计算机任务上的表现没有变化。探索参与者服用LDX的经历的访谈发现了四个共同主题:缓解饮食失调,功能和生活质量的改善,重新恢复的希望,以及使饮食正常化的能力。该报告提出了几种潜在的方法,LDX可以减少BN患者的暴饮暴食和吹扫症状。重要的是,由于研究的规模和类型,我们不能断定观察到的变化是药物治疗的直接结果.相反,我们的结果应该被用来形成新的问题,可以通过具有受控设计的大型研究来探索。
BACKGROUND: There is emerging evidence that stimulants warrant further investigation as a treatment for bulimia nervosa (BN) including a recent open-label feasibility
trial examining the use of lisdexamfetamine dimestylate (LDX) for BN. The current report presents the secondary outcomes and qualitative interview results from that feasibility
trial. These outcomes explore several purported mechanisms that may explain how stimulants affect symptoms of BN: appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology/impairment and reward-based decision-making.
METHODS: Twenty-three participants with BN received LDX for eight weeks. Questionnaires assessing appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology and impairment were administered at baseline and post-treatment. Participants also completed a two-step reinforcement learning task to assess their decision-making. Semi-structured interviews took place at baseline, week 5, and follow-up.
RESULTS: Reductions in hunger, food-related impulsivity, obsessive and compulsive features, eating disorder psychopathology and impairment were found. However, reward learning, as far as it is assessed by the task, did not seem to contribute to the effect of LDX on BN symptoms. Qualitative analysis suggested four themes: (1) reprieve from the eating disorder, (2) improvement in function and quality of life, (3) renewed hope for recovery, and (4) ability to normalize eating.
CONCLUSIONS: This report suggests several potential mechanisms by which LDX may reduce symptoms of binging and purging in those with BN. Importantly, due to the open-label design, we are unable to attribute findings to the medication. Instead, our results should be interpreted as hypothesis generating to inform future studies such as adequately powered randomized controlled trials.
Trial registration NCT03397446.
Recent research suggests that stimulant medications could be a potential treatment for bulimia nervosa (BN). Participants in this study took lisdexamfetamine dimesylate (LDX) for 8 weeks while their eating disorder symptoms and medical status were carefully monitored. As part of this
study, twenty-three participants with BN completed several interviews, questionnaires and computer tasks at the start and end of treatment which were delivered to help researchers learn more about the how LDX impacts people with BN. Scores on questionnaires measuring different aspects of the eating disorder improved over time. Participants’ performance on the computer task which measures a type of decision making did not change during treatment. Interviews exploring participants’ experience taking LDX found four common themes: reprieve from the eating disorder, improvement in function and quality of life, renewed hope for recovery, and ability to normalize eating. This report suggests several potential ways LDX may reduce symptoms of binging and purging in those with BN. Importantly, due to the size and type of
study, we cannot conclude that changes observed were a direct result of the medication. Instead, our results should be used to form new questions that can be explored by larger studies with controlled designs.