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.

项目概要/摘要 饮食失调 (ED) 是一种严重的精神疾病：每 52 分钟就有一人死于 ED。 ED 与一系列负面结果高度相关，包括公共卫生和个人健康 疾病负担、医疗和心理合并症以及健康的社会决定因素 （SDOH）。 ED 的治疗效果不佳；没有循证治疗 适用于患有神经性厌食症 (AN) 或其他特定进食或饮食失调 (OSFED) 的成人 只有 50% 的成年人对当前基于证据的治疗有反应。没有精确度 现有的治疗方法，也没有任何考虑社会背景的治疗方法。个性化 迫切需要考虑社会背景的 ED 治疗方法以改善治疗 反应并尽量减少与这些疾病相关的痛苦。我们的总体目标，延伸 根据我们过去的工作，是根据具体情况（或一个人）创建一种个性化的治疗方法 模型（称为 Transdiagnostic Network Informed Personalized Treatment for EDs；T-NIPT- 埃德）。我们将进行两阶段研究，系统地表征各个机制 治疗（第一阶段：N=900），然后测试每个治疗模块的疗效（第二阶段： 与当前的金标准治疗（认知治疗）相比，N = 240（来自第一阶段） 行为疗法增强：CBT-E）。我们的研究目标是 (1) 描述患病率 T-NIPT-ED精准治疗机制及医学心理共病的研究 （例如，肥胖；抑郁症）、个人疾病负担（例如，残疾）、SDOH（例如，食物 不安全）以及这些机制特有的公共卫生结果（例如服务利用）， (2) 确定个性化目标机制在与基于证据的匹配时是否会得到改善 T-NIPT-ED 的治疗模块和 (3) 测试 T-NIPT-ED 的变化是否与 改善结果（与 CBT-E 相比），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 最终实现了第一个针对 ED 的精准治疗，并且可以扩展到其他领域 精神疾病。拟议的研究采用了高度创新的方法；密集的 通过移动技术收集的纵向数据与最先进的具体信息相结合 提供虚拟、个性化治疗的建模方法。该提案整合了 广泛评估（例如 SDOH；公共卫生负担）和具体评估（例如 ED 症状） 结果，以确保社会背景可以融入个性化。拟议的 研究具有很高的临床影响。最终，该提案将直接导致创建和 传播基于证据的针对 ED 的个性化治疗，以及意愿 成为整个精神病学领域精准治疗发展的典范。