Innovations in Personalizing Treatment for Eating Disorders Using Idiographic Methods and the Impact of Personalization on Psychological, Physical, and Sociodemographic Outcomes

使用具体方法对饮食失调进行个性化治疗的创新以及个性化对心理、身体和社会人口学结果的影响

• 批准号: 10685796
• 负责人: Cheri Alicia Levinson
• 金额: $ 141.2万
• 依托单位: UNIVERSITY OF LOUISVILLE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10685796
• 关键词: Adult; Anorexia Nervosa; Clinical; Cognitive Therapy; Data; Diagnostic; Eating Disorders; Evidence based treatment; Goals; Individual; Lead; Medical; Mental Depression; Mental disorders; Methods; Modeling; Obesity; Outcome; Persons; Phase; Precision therapeutics; Prevalence; Psychiatry; Public Health; Research; Social Environment; Specific qualifier value; Symptoms; Testing; United States National Institutes of Health; Work; burden of illness; comorbidity; disability; efficacy testing; evidence base; feeding; food insecurity; improved; improved outcome; innovation; mobile computing; personalized medicine; psychologic; public health relevance; service utilization; severe mental illness; social health determinants; sociodemographics; standard care; therapy development; treatment response; virtual

PROJECT SUMMARY/ABSTRACT Eating disorders (EDs) are serious mental illness: someone dies of an ED every 52 minutes. EDs are highly related to a host of negative outcomes, including public health and individual disease burden, medical and psychological comorbidities, and social determinants of health (SDOH). Treatment response for EDs are suboptimal; there are no evidence-based treatment for adults with anorexia nervosa (AN) or Other Specified Feeding or Eating Disorder (OSFED) and only 50% of adults respond to current evidence based treatments. There are no precision treatments, nor any treatments that consider social context, in existence. Personalized treatments for EDs, that consider social contexts, are urgently needed to improve treatment response and minimize the suffering associated with these illnesses. Our overall goal, extending upon our past work, is to create a treatment personalized based on idiographic (or one person) models (termed Transdiagnostic Network Informed Personalized Treatment for EDs; T-NIPT- ED). We will carry out a two-phase study to systematically characterize individual mechanisms of treatment (Phase I: N=900) and then test the efficacy of each treatment module (Phase II: N=240 drawn from Phase I) compared to the current gold-standard treatment (Cognitive Behavioral Therapy Enhanced: CBT-E). Our study goals are to (1) characterize the prevalence of T-NIPT-ED precision treatment mechanisms and medical and psychological comorbidities (e.g., obesity; depression), individual disease burden (e.g., disability), SDOH (e.g., food insecurity), and public health outcomes (e.g., service utilization) specific to these mechanisms, (2) identify if personalized target mechanisms improve when matched to evidence-based treatment modules of T-NIPT-ED and (3) test if change in T-NIPT-ED is associated with improved outcomes (vs CBT-E), including ED outcomes, comorbidities, disease burden, and public health outcomes and if these outcomes are moderated by SDOH. These goals will ultimately lead to the very first precision treatment for ED and can be extended to additional psychiatric illnesses. The proposed research uses highly innovative methods; intensive longitudinal data collected with mobile technology is combined with state-of-the art idiographic modeling methods to deliver a virtual, personalized treatment. This proposal integrates assessment of broad (e.g., SDOH; public health burden) and specific (e.g., ED symptoms) outcomes, to ensure that social context can be integrated into personalization. The proposed research has high clinical impact. Ultimately, this proposal will lead directly to the creation and dissemination of an evidence-based individually-personalized treatment for EDs, as well as will serve as an exemplar for precision treatment development across the entire field of psychiatry.

项目摘要/摘要 饮食失调（ED）是严重的精神疾病：有人每52分钟死亡。 EDS与许多负面结果高度相关，包括公共卫生和个人 疾病负担，医学和心理合并症以及健康的社会决定因素 （SDOH）。 ED的治疗反应是次优的；没有循证治疗 对于患有神经性厌食症的成年人（AN）或其他指定的喂养或饮食失调（OSFED） 只有50％的成年人对当前的基于证据的治疗做出反应。没有精度 治疗方法，也没有任何考虑社会背景的治疗方法。个性化 急需考虑社会环境的ED治疗以改善治疗 反应并最大程度地减少与这些疾病相关的苦难。我们的总体目标，扩展 在我们过去的工作中，是基于印度（或一个人）来创建个性化的治疗 模型（称为转诊网络为EDS提供个性化治疗； T-NIPT- ed）。我们将进行两阶段的研究，以系统地表征单个机制 治疗（I阶段：n = 900），然后测试每个处理模块的功效（II阶段： n = 240阶段I）与当前的金色标准处理相比（认知 行为疗法增强：CBT-E）。我们的学习目标是（1）表征患病率 T-NIPT-ED精密治疗机制以及医学和心理合并症 （例如，肥胖；抑郁症），个体疾病负担（例如残疾），SDOH（例如食物 不安全感）和这些机制特有的公共卫生结果（例如，服务利用率）， （2）确定与基于证据的个性化目标机制是否有所改善 T-NIPT-ED的治疗模块和（3）测试如果T-NIPT-ED的变化与 改进的结果（VS CBT-E），包括ED结果，合并症，疾病负担和 公共卫生结果以及这些结果是否由SDOH调节。这些目标将 最终导致ED的第一个精度治疗，可以扩展到额外 精神病。拟议的研究使用了高度创新的方法。密集的 用移动技术收集的纵向数据与最先进 建模方法可提供虚拟的个性化处理。该提案整合了 评估广泛（例如SDOH；公共卫生负担）和特定（例如ED症状） 结果，以确保可以将社会环境纳入个性化。提议 研究具有很高的临床影响。最终，该提案将直接导致创建和 传播基于循证的ED的单独人物治疗，以及 作为整个精神病学领域精确治疗开发的典范。