Family Therapy and Fluoxetine in the Treatment of Adolescents

家庭治疗和氟西汀治疗青少年

• 批准号: 7033288
• 负责人: HARRY A BRANDT
• 金额: $ 18.29万
• 依托单位: SHEPPARD AND ENOCH PRATT HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7033288
• 关键词: adolescence (12-20); anorexia nervosa; antidepressants; anxiety; behavior therapy; behavioral /social science research tag; blood tests; body composition; clinical research; clinical trials; comorbidity; cooperative study; drug screening /evaluation; family structure /dynamics; family therapy; fluoxetine; human subject; human therapy evaluation; interview; longitudinal human study; mental disorder chemotherapy; nutrition; obsessive compulsive disorder; psychological tests; serotonin inhibitor

DESCRIPTION (provided by applicant): The long-term objective of this proposal is to enhance the treatment and outcome of anorexia nervosa (AN) and to develop a network of research and training centers to support innovative research in AN. Research on the treatment of AN has lagged that of other conditions, even other eating disorders such as bulimia nervosa, hence it is important to test potentially effective treatments in a large scale study so as to provide a baseline for future studies. The focus of this proposal is on adolescent AN. Successful early treatment is likely to reduce the prevalence of chronic AN with its high rates of morbidity and mortality and high health care costs. The most promising treatment for adolescent AN is a specific form of family therapy, (the Maudsley approach) called here, behavioral family therapy (BFT). This treatment is focused on the disordered eating behavior that characterizes AN and enables parents to refeed their child. Additionally, there is preliminary evidence that fluoxetine may be useful in reducing comorbid psychopathology and enhancing maintenance in AN. However, there has been no placebo controlled study of fluoxetine in adolescent AN. Moreover, although there have been several small-scale studies of BFT there has been no controlled comparison with another form of family therapy. Hence, we propose to use systems family therapy (SFT) which has been developed and manualized to represent the type of family therapy practiced in the community. We propose to randomly allocate 240 adolescents aged 12-18 years with AN and their families to one of 4 groups: BFT + placebo; BFT + fluoxetine; SFT + placebo; and SFT + fluoxetine. Medication will be continued for 6-months beyond the end of family therapy to assess medication effects on the maintenance of therapeutic gains. Treatment and assessment will be carried out at 6 clinical sites with 40 subjects per site with separate data and coordinating centers. The treatment sites will follow common assessment and treatment protocols with detailed monitoring of recruitment, treatment, assessment and human subjects procedures by the coordinating center. The results of this study should provide guidance to clinicians concerning optimal treatment approaches for adolescent AN. From the public health perspective, development of effective treatments for adolescents will reduce the morbidity, mortality, and high costs associated with chronic AN.

描述（由申请人提供）：该提案的长期目标是加强神经性厌食症（AN）的治疗和结果，并开发一个研究和培训中心网络以支持神经性厌食症的创新研究。 AN 治疗的研究落后于其他疾病，甚至其他饮食失调如神经性贪食症，因此在大规模研究中测试潜在有效的治疗方法非常重要，以便为未来的研究提供基线。该提案的重点是青少年 AN。慢性 AN 的发病率和死亡率较高，且医疗费用较高，成功的早期治疗可能会降低慢性 AN 的患病率。青少年 AN 最有希望的治疗方法是一种特定形式的家庭治疗（莫兹利方法），这里称为行为家庭治疗 (BFT)。这种治疗的重点是 AN 所特有的饮食失调行为，使父母能够重新喂养孩子。此外，初步证据表明氟西汀可能有助于减少 AN 的共病精神病理学并增强维持。然而，尚无氟西汀治疗青少年 AN 的安慰剂对照研究。此外，尽管已经进行了几项 BFT 的小规模研究，但尚未与其他形式的家庭治疗进行对照比较。因此，我们建议使用系统家庭治疗（SFT），它已被开发和手册化以代表社区中实施的家庭治疗类型。我们建议将 240 名 12-18 岁患有 AN 的青少年及其家人随机分配到 4 组中的一组：BFT + 安慰剂； BFT+氟西汀； SFT+安慰剂；和 SFT + 氟西汀。家庭治疗结束后，将继续用药 6 个月，以评估药物对维持治疗效果的影响。治疗和评估将在 6 个临床中心进行，每个中心有 40 名受试者，具有独立的数据和协调中心。治疗中心将遵循共同的评估和治疗方案，并由协调中心对招募、治疗、评估和人类受试者程序进行详细监控。这项研究的结果应该为临床医生提供有关青少年 AN 最佳治疗方法的指导。从公共卫生的角度来看，开发针对青少年的有效治疗方法将降低慢性 AN 的发病率、死亡率和高昂费用。