难治性神经性厌食症手术治疗的临床研究
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摘要
背景和目的：
神经性厌食症是一种进食障碍,其特征是由于进食明显减少所致体重明显减轻、闭经,通常伴有体像障碍、强迫症状等其它精神障碍。随着病情进展,患者可出现阵发性暴食与暴食后呕吐症状。传统的神经性厌食症的治疗方法主要有心理治疗和药物治疗,往往对早期患者有一定疗效,但大多数患者经历长期的心理、药物治疗无明显效果,成为难治性神经性厌食症。难治性神经性厌食症具有较高的死亡率,常死于严重营养不良、电解质紊乱、多器官衰竭等并发症。近年来脑立体定向手术用于治疗难治性强迫症,具有安全、微创、副作用少的特点,显著改善率在90%以上。由于神经性厌食症与强迫症都属于强迫谱系障碍,临床上具有许多共同特点,因此从2006年以来,我们采用手术方法治疗难治性神经性厌食症患者,即心理、药物治疗无效的严重患者。
在长期的手术治疗中我们发现,由于病程长短、临床症状严重程度对于手术方法的选择及治疗预后及起了关键作用,因此我们依据患者的不同临床特征进行临床分级研究(Ⅰ-Ⅳ级),期望该临床分级可以在手术时机的判断、手术方式的选择及预后判断有所帮助。
方法：
在所有接受手术治疗的104例神经性厌食症患者中随访到术后6个月以上的61例患者,将这61例患者手术前后主要症状、病程、体重身高指数、月经是否正常、是否伴人格改变及日常生活能力量表(ADL量表)、简明智力量表、Yale-Brown强迫症量表(Y-Bocs量表),汉密顿焦虑量表(HAMA量表),汉密顿抑郁量表(HAMD量表)等指标进行对照研究,依据术前临床症状进行分级,根据不同分级选择不同手术方式,如立体定向下双侧伏隔核电刺激术或立体定向下双侧内囊前肢毁损术,随访时间6-64个月,平均(26.15±10.47)个月。
结果：
大部分患者术后神经性厌食症症状明显缓解,其中有2例于术后6个月、10个月复发,再次行立体定向下双侧内囊前肢毁损术,症状有明显改善,至随访时病情稳定。1例Ⅳ级患者术后症状无改善,于术后18个月自杀死亡。其余所有患者至随访时,体重身高指数大于17.5者占85.37%,其中Ⅱ、Ⅲ级患者均恢复正常；30例术前闭经者术后恢复正常,7例由不规律转为规律,其中Ⅱ、Ⅲ级患者均治愈,Ⅳ级患者中有83.87%治愈；手术前后除简明智力量表无明显统计学意义,其余4项量表评分显示手术前后有显著差异,Ⅱ、Ⅲ级患者改善程度为明显有效或有效,Ⅳ级患者分别出现明显有效、有效、改善甚至无效。其中对强迫症状缓解程度最佳,焦虑症状其次,抑郁症状最差；手术前后体像障碍变化有统计学意义,术后对肥胖恐惧者远少于术前,术前休学或不能工作的患者术后恢复学习和工作,有明显统计学差异。
结论：
通过对神经厌食症分级可以根据疾病严重程度实施相应的治疗方案,选择适当的手术方式,有利于提高患者术后的疗效及预后判断,对术后患者的后续治疗有指导意义；手术对神经性厌食症患者的体重改善疗效显著,改善率达到90.24%,t统计检验表明手术后体重身高指数(BMI值)增高达到极显著水平(t=9.32.P<0.0001)；手术对神经厌食症患者的月经具有显著的治愈和改善效果(Wilcoxon符号秩和检验,统计量为S,得S=297.5,P<0.01)；手术对神经性厌食症患者的精神科量表相关指标改善明显,Y-BOCS量表, HAMA量表,HAMD量表评分手术前后t检验有明显统计学意义,总有效率(显效+有效+改善)分别为82.94%,85.37%,90.25%。t统计检验表明手术前后各项指标差异均达到极显著水平。
Background and Objectives:
Anorexia nervosa is an eating disorder which is an important cause of physical and psychosocial morbidity in adolescent girls and young adult women. Common signs and symptoms include loss of subcutaneous fat tissue, orthostatic hypotension, bradycardia, impaired menstruation, hair loss and hypothermia. Many other psychiatric conditions often co-exist in50to70percent of patients such as major depression or dysthymia, anxiety disorders and obsessive-compulsive disorder (OCD). Almost50%of patients are refractory to all current medical treatment and never fully recover and the standardized mortality ratio over the first10years is about10%.
With the progress of the illness,the symptom of episodic overeating and vomiting will emerge.Thetraditional treatment for AN are psychological treatment and medication.Patients often have a certain effect with these treatment on early stage.However,most of patient have experienced repeated long-term medical treatment,and become refractory AN patients with a high mortality rate.Patients often died of severe malnutration,electrolyte imbalance,multiple organ failure and other complications.In recent years,the sterotactic brain surgery became a safe、minimal invasive、less side effect treatment that is used for the treatment of retractory Obssessive-compulsive disorder(OCD).AN and OCD are all belong to the forcing spectrum disorders.There are many common clinical features.Our center have been used surgical treatment with AN patients since the year2006.
We discovered from the surgical treatment that:The severity of clinical symptoms played a key role in the choice of surgical methods and the prognosis of the illness.Therefore,we based on different clinical features of patients to outline and classify the illness,expect that the clinical classification can be of help for determing the timing of surgery,the chooice of surgery procedure and prognosis.
Method:
61patients from the overall104surgical treated patients were successfully follow-up.The material of major symptoms such as course of disease、body mass index(BMI)、menia、Yale-brown OCD Scale、Hamilton Anxiety Scale、Hamilton Depression Scale、Concise Intelligent Scale were well collected for controlled study.The clinical classifucation is based on the clinical symptoms before the surgery.
Results:
2DBS cases of grade IV patient were relapsed6and10months after the surgery, respectively. Who then have received biladeral stereotactic internal capsulotomy and then significantly inproved.They were still in stable condition the time of follow-up.1case of grade IV patient have no improvement and died from suicide18months after surgery.
85.37%patients have their BMI over17.5in all living patients.Ⅱ、Ⅲ grade patients returned to normal level;30cases of amenorrhea before surgery returned to normal after the operation.7cases were menia irregular and retured to normal after surgery.Grade Ⅱ、Ⅲ patients were cured,83.87%of grade IV patients were cured;Except to Concise Intelligent Scale was no statistically significant before and after surgery,the scores of the remaining four scales showed a significant difference before and after surgery. The operation is best for the improvement of obsessive symptoms,second,anxiety symptoms,last,depression.Change in body image disorders before and after surgery was ststistically significant.
神经性厌食症是一种进食障碍,其特征是由于进食明显减少所致体重明显减轻、闭经,通常伴有体像障碍、强迫症状等其它精神障碍。随着病情进展,患者可出现阵发性暴食与暴食后呕吐症状。传统的神经性厌食症的治疗方法主要有心理治疗和药物治疗,往往对早期患者有一定疗效,但大多数患者经历长期的心理、药物治疗无明显效果,成为难治性神经性厌食症。难治性神经性厌食症具有较高的死亡率,常死于严重营养不良、电解质紊乱、多器官衰竭等并发症。近年来脑立体定向手术用于治疗难治性强迫症,具有安全、微创、副作用少的特点,显著改善率在90%以上。由于神经性厌食症与强迫症都属于强迫谱系障碍,临床上具有许多共同特点,因此从2006年以来,我们采用手术方法治疗难治性神经性厌食症患者,即心理、药物治疗无效的严重患者。
在长期的手术治疗中我们发现,由于病程长短、临床症状严重程度对于手术方法的选择及治疗预后及起了关键作用,因此我们依据患者的不同临床特征进行临床分级研究(Ⅰ-Ⅳ级),期望该临床分级可以在手术时机的判断、手术方式的选择及预后判断有所帮助。
方法：
在所有接受手术治疗的104例神经性厌食症患者中随访到术后6个月以上的61例患者,将这61例患者手术前后主要症状、病程、体重身高指数、月经是否正常、是否伴人格改变及日常生活能力量表(ADL量表)、简明智力量表、Yale-Brown强迫症量表(Y-Bocs量表),汉密顿焦虑量表(HAMA量表),汉密顿抑郁量表(HAMD量表)等指标进行对照研究,依据术前临床症状进行分级,根据不同分级选择不同手术方式,如立体定向下双侧伏隔核电刺激术或立体定向下双侧内囊前肢毁损术,随访时间6-64个月,平均(26.15±10.47)个月。
结果：
大部分患者术后神经性厌食症症状明显缓解,其中有2例于术后6个月、10个月复发,再次行立体定向下双侧内囊前肢毁损术,症状有明显改善,至随访时病情稳定。1例Ⅳ级患者术后症状无改善,于术后18个月自杀死亡。其余所有患者至随访时,体重身高指数大于17.5者占85.37%,其中Ⅱ、Ⅲ级患者均恢复正常；30例术前闭经者术后恢复正常,7例由不规律转为规律,其中Ⅱ、Ⅲ级患者均治愈,Ⅳ级患者中有83.87%治愈；手术前后除简明智力量表无明显统计学意义,其余4项量表评分显示手术前后有显著差异,Ⅱ、Ⅲ级患者改善程度为明显有效或有效,Ⅳ级患者分别出现明显有效、有效、改善甚至无效。其中对强迫症状缓解程度最佳,焦虑症状其次,抑郁症状最差；手术前后体像障碍变化有统计学意义,术后对肥胖恐惧者远少于术前,术前休学或不能工作的患者术后恢复学习和工作,有明显统计学差异。
结论：
通过对神经厌食症分级可以根据疾病严重程度实施相应的治疗方案,选择适当的手术方式,有利于提高患者术后的疗效及预后判断,对术后患者的后续治疗有指导意义；手术对神经性厌食症患者的体重改善疗效显著,改善率达到90.24%,t统计检验表明手术后体重身高指数(BMI值)增高达到极显著水平(t=9.32.P<0.0001)；手术对神经厌食症患者的月经具有显著的治愈和改善效果(Wilcoxon符号秩和检验,统计量为S,得S=297.5,P<0.01)；手术对神经性厌食症患者的精神科量表相关指标改善明显,Y-BOCS量表, HAMA量表,HAMD量表评分手术前后t检验有明显统计学意义,总有效率(显效+有效+改善)分别为82.94%,85.37%,90.25%。t统计检验表明手术前后各项指标差异均达到极显著水平。
Background and Objectives:
Anorexia nervosa is an eating disorder which is an important cause of physical and psychosocial morbidity in adolescent girls and young adult women. Common signs and symptoms include loss of subcutaneous fat tissue, orthostatic hypotension, bradycardia, impaired menstruation, hair loss and hypothermia. Many other psychiatric conditions often co-exist in50to70percent of patients such as major depression or dysthymia, anxiety disorders and obsessive-compulsive disorder (OCD). Almost50%of patients are refractory to all current medical treatment and never fully recover and the standardized mortality ratio over the first10years is about10%.
With the progress of the illness,the symptom of episodic overeating and vomiting will emerge.Thetraditional treatment for AN are psychological treatment and medication.Patients often have a certain effect with these treatment on early stage.However,most of patient have experienced repeated long-term medical treatment,and become refractory AN patients with a high mortality rate.Patients often died of severe malnutration,electrolyte imbalance,multiple organ failure and other complications.In recent years,the sterotactic brain surgery became a safe、minimal invasive、less side effect treatment that is used for the treatment of retractory Obssessive-compulsive disorder(OCD).AN and OCD are all belong to the forcing spectrum disorders.There are many common clinical features.Our center have been used surgical treatment with AN patients since the year2006.
We discovered from the surgical treatment that:The severity of clinical symptoms played a key role in the choice of surgical methods and the prognosis of the illness.Therefore,we based on different clinical features of patients to outline and classify the illness,expect that the clinical classification can be of help for determing the timing of surgery,the chooice of surgery procedure and prognosis.
Method:
61patients from the overall104surgical treated patients were successfully follow-up.The material of major symptoms such as course of disease、body mass index(BMI)、menia、Yale-brown OCD Scale、Hamilton Anxiety Scale、Hamilton Depression Scale、Concise Intelligent Scale were well collected for controlled study.The clinical classifucation is based on the clinical symptoms before the surgery.
Results:
2DBS cases of grade IV patient were relapsed6and10months after the surgery, respectively. Who then have received biladeral stereotactic internal capsulotomy and then significantly inproved.They were still in stable condition the time of follow-up.1case of grade IV patient have no improvement and died from suicide18months after surgery.
85.37%patients have their BMI over17.5in all living patients.Ⅱ、Ⅲ grade patients returned to normal level;30cases of amenorrhea before surgery returned to normal after the operation.7cases were menia irregular and retured to normal after surgery.Grade Ⅱ、Ⅲ patients were cured,83.87%of grade IV patients were cured;Except to Concise Intelligent Scale was no statistically significant before and after surgery,the scores of the remaining four scales showed a significant difference before and after surgery. The operation is best for the improvement of obsessive symptoms,second,anxiety symptoms,last,depression.Change in body image disorders before and after surgery was ststistically significant.
引文
[1]陈珏,张明岛,肖泽萍.神经性厌食症的社会心理因素[J].上海精神医学,2004,16(5)：298-300.
[2]江开达主编.精神病学.北京：人民卫生出版社,2005,179页.
[3]Hoek HW,van Hoeken D.Review of the prevalence and incidence of eating disorders.Int J Eat Disorder 2003;34:383-96.
[4]Tamburrino MB,Mcginnis RA.Anorexia nervosa.A review.Panminerva Med,2002,44(4):301-311.
[5]Bulik CM,Sullivan PF,Fear JL,JoycePR.Eating disorder and antecedent anxiety disorders:a controlled study.Acta Psychiatr Scand 1997;96:101-7.
[6]Halmi KA,Sunday SR,Klump KL,et al. Obsessions and compulsions in anorexia nervosa subtypes.Int J Eat Disord 2003;33:308-19.
[7]Diagnostic and statistical manual of mental disorders,4th ed,:DSM-IV-TR.Washington D.C.: American Psychiatry Association,2000.
[8]SteinerH,Kwan W,Shaffer TQet al.Risk and protective factors for juvanile eating disordes.Eur child Adolesc Psychiatry2003;12:Suppl 1:38-46.
[9]Key A, Lacey H. Progress in eating disorder research[J]. Curr Opin Psychiatry 2002,15(2):143-148.
[10]孙伯民,李殿友,郎黎琴,等.内囊前肢毁损术治疗难治性强迫症.中围神经精神疾病杂志,2003,29：81-83.
[11]Practice guidelines for the treatment of patients with eating disorders(revision):American Psychiatric Association Work Group on Eating Disorders.Am J Psychiatry 2000;157:Suppll:l-39.
[12]Hay P,Bacaltchuk J,Claudino A,et al;Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa.Cochrane Database Syst Rev 2003;4:Cd003909.
[13]Attia E,Haiman C,Walsh BT,et al;Does fluoxetine augment inpatient treatment of anorexia nervosa? Am Jpsychiatry 1998; 155:548-51.
[14]Strober M,Pataki C,Freeman R,et al.No effect of adjunctive fluoxetine on eating behavior or weight phobia during the inpatient of anorexia nervosa:an historical case-control study.J Child Adolesc Psychopharmacol 1999;9:195-201.
[15]Barbarich NC,McConaha CW,Gaskill J,et al.An open trial of olanzapine in anorexia nervosa.J Clin Psychiatry 2004;65:1480-2.
[16]Malina A,Gaskill J,McConha C,et al.Olanzapine treatment of anorexia nervosa:a retrospective study.Int J Eat Disord 2003;33:234-7.
[17]Powers PS,Santana CA,Bannon YS.Olanzapine in the treatment of anorexia nervosa:an open label trial.Int J Eat Disord2002;32:146-54.
[19]吴承瀚,李锋,潘宜新,孙伯民。功能神经外科治疗神经性厌食症的回顾与前瞻,医学综述,2010,16(15),2290-2292.
[20]李轶琛,王继中,马筠。单用西酞普兰与合并家庭治疗对神经性厌食症患者的疗效,上海精神医学,2006,18(3),158-160.
[21]陈玉龙,王霞。米氮平治疗神经性厌食症患者的疗效对照研究,中国心理卫生杂志,2005,19(9),640-642.
[22]Attia E,Kaplan AS,Walsh BT, et al.Olanzapine versus placebo for out-patients with anorexia nervosa, Psychol Med.2011 (22):1-6.
[23]Barbarich NC,Mcconaha CW,Gaskill J,et al.An open trial of olanzapine in anorexia nervosa [J],J clin Psychiatry,2004,65(11):1480-1482.
[24]Boachie A,Goldfield GS,Spetting W, et al.Olanzapine use as an adjunctive treatment for hospitalized children with anrexia nervosa:case report.[J],Int J Eat Disorder,2003,33(1):98-103.
[25]Hansen L,Olanzapine in the treatment of anorexia nervosa [J],Br J Psychiatry.1999,175:592.
[26]周朝昀,陈珏,张冰,张海音,肖泽萍。神经性厌食症患者父母的生命质量研究,四川精神卫生,2009,22(4),209-210.
[1]Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int [J]. Eat Disord 2003,34:383-96.
[2]Urwin RE, Nunn KP. Epistatic interaction between the monoamine oxidase A and serotonin transporter genes in anorexia nervosa. Eur [J]. Hum Genet 2005,13:370-5.
[3]Bulik CM, Sullivan PF, Fear JL, et al.Eating disorders and antecedent anxiety dis-orders:a controlled study. Acta PsychiatrScand,1997,96:101-7.
[4]Halmi KA, Sunday SR, Klump KL, et al.Obsessions and compulsions in anorexia nervosa subtypes. Int [J] Eat Disord,2003,33:308-19.
[5]Godart NT, Flament MF, Curt F, et al.Anxiety disorders in subjects seeking treatment for eating disorders:a DSM-IV controlled study. Psychiatry Res 2003,117:245-58.
[6]Steiner H, Kwan W, Shaffer TQ et al.Risk and protective factors for juvenile eating disorders. Eur Child Adolesc Psychiatry[J],2003,12:Suppl 1:38-46.
[7]Garfinkel PE, Lin E, Goering P, et al.Should amenorrhoea be necessary for the diagnosis of anorexia nervosa? Evidence from a Canadian community sample. [J]Psychiatry,1996,168:500-6.
[8]第8届亚洲功能神经外科大会会议摘要第81页
[9]章晓云,钱铭怡,进食障碍的心理干预[J].中国心理卫生杂志,2004,(18)1：31-34.
[10]Olmsted M.P.,Davis R.,Garner David M.,et al.Efficacy of a brief group psychoeducational intervention for bulimia nervosa[J].Erratum. Behaviour-Research-and-Therapy,1991,29(3):305.
[11]钱铭怡主编,心理治疗,吉林教育出版社,2002年,第173页
[12]Murphy R, Straebler S, Cooper Z, Fairburn CG,et al.Cognitive behavioral therapy for eating disorders[J].Psychiatr Clin North Am.2010,33(3):611-27.
[13]Lock J, Le Grange D, Agras WS,et al.A randomized clinical trial comparing family based treatment to adolescent focused individual therapy for adolescents with anorexia nervosa[J]. Arch Gen Psychiatry,2010,67:1025-1032.
[14]Fitzpatrick K, Moye A, Hostee R, et al. Adolescent focused therapy for adolescent anorexia nervosa[J].Contemp Psychother,2010; 40:31-39.
[15]Robin A, Siegal P, Moye A, et al.A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa[J]. Am Acad Child Adolesc Psychiatry, 1999,38:1482-1489.
[16]Roberto C, Steinglass J, Walsh BT. The clinical significance of amenorrhea as a diagnostic criterion for anorexia nervosa[J]. Eat Disord,2008; 41:559-563.
[17]Brambilla F, Draisci A, Peirone A, et al. Combined cognitive-behavioral,psychopharmacological and nutritional therapy in eating disorders.2. Anorexia nervosa—binge-eating/purging type. Neuropsychobiology,1995,32:64-7.
[18]Gwirtsman HE, Guze BH, Yager J, et al. Fluoxetine treatment of Anorexia Nervosa:an open clinical trial.[J]. Clin Psychiatry,1990,51:378-382.
[19]Fassino S, Leombruni P, Daga G, et al.2002. Efficacy of citalopram in anorexia nervosa: a pilot study[J]. Eur Neuropsychopharmacol,2002,12:453-459.
[20]Holtkamp K, Konrad K, Kaiser N, et al. A retrospective study of SSRI treatment in adolescent anorexia nervosa:insuffi cient evidence for efficacy[J]. Psychiatr Res,2005,39:303-
10.
[21]Walsh BT, Kaplan AS, Attia E, et al. Fluoxetine after weight restoration in anorexia nervosa:a randomized controlled trial[J]. JAMA.,2006,295:2605-2612.
[22]Lacey JH, Crisp AH. Hunger, food intake and weight:the impact of clomipramine on a refeeding anorexia nervosa population[J]. Postgrad Med J,1980,56 (Suppl 1):79-85.
[23]Biederman J, Herzog DB, Rivinus TM, et al. Amitriptyline in the treatment of anorexia ner-vosa:a double-blind, placebo-controlled study[J]. Clin Psychopharmacol,19855:10-6.
[24]Halmi KA, Eckert E, LaDu TJ,et al. Anorexia nervosa. Treatment effi cacy of cyproheptadine and amitriptyline[J]. Arch Gen Psychiatry,1986,43:177-181.
[25]Crisp AH, Lacey JH, Crutchfi eld M. Clomipramine and " Drive " in people with anorexia nervosa:An in-patient study[J]. Br J Psychiatry,1987,150:355-358.
[26]Vandereycken W. Neuroleptics in the short-term treatment of ano-rexia nervosa. A double-blind placebo-controlled study with sulpir-ide. Br J Psychiatry,1984; 144:288-292
[27]Brambilla F, Garcia CS, Fassino S, et al. Olanzapine therapy in anorexia nervosa: psychobiological effects[J]. Int Clin Psychopharmacol.2007;22:197-204
[28]Fisman S, Steele M, Short J, et al. Case study:anorexia nervosa and autistic disorder in an adolescent girl[J]. Am Acad Child Adolesc Psychiatry,1996,35:937-940.
[29]Newman-Toker J. Risperidone in anorexia nervosa.[J]. Am Acad Child Adolesc Psychiatry,2000,39:941-942.
[30]Bosanac P, Kurlender S, Norman T, et al. An open-label study of quetiapine in anorexia nervosa[J]. Hum Psychopharmacol,2007,22:223-230.
[31]Court A, Mulder C, Kerr M, et al. Investigating the effectiveness, safety and tolerability of quetiapine in the treatment of anorexia ner-vosa in young people:a pilot study. [J]. Psychiatr Res,2010,44:1027-34.
[32]Hill K, Bucuvalas J, McClain C, et al. Pilot study of growth hormone administration during the refeeding of malnourished anorexia nervosa patients[J]. Child Adolesc Psychopharmacol.,2000,10:3-8.
[33]Miller KK, Grieco KA, Klibanski A. Testosterone administration in women with anorexia nervosa[J]. Clin Endocrinol Metab.,2005,90:1428-1433.
[34]Lim, L. A., McGovern, L., Elamin, M. B,et al.Effect on bone health of estrogen preparations in premenopausal women with anorexia nervosa:A systematic review and meta-analyses[J].International Journal of Eating Disorders,2010,43,218-225.
[35]Mehler, P. S., MacKenzie, T. D.aTreatment of osteopenia and osteoporosis in anorexia nervosa:a systematic review of the literature[J]. International Journal of Eating Disorders, 2009,42:195-201.
[36]Taveggia C, Thaker P, Petrylak A, et al. Type III neuregulin-1 promotes oligodendrocyte myelination[J]. Glia,2008,56(3):284-93.
[2]江开达主编.精神病学.北京：人民卫生出版社,2005,179页.
[3]Hoek HW,van Hoeken D.Review of the prevalence and incidence of eating disorders.Int J Eat Disorder 2003;34:383-96.
[4]Tamburrino MB,Mcginnis RA.Anorexia nervosa.A review.Panminerva Med,2002,44(4):301-311.
[5]Bulik CM,Sullivan PF,Fear JL,JoycePR.Eating disorder and antecedent anxiety disorders:a controlled study.Acta Psychiatr Scand 1997;96:101-7.
[6]Halmi KA,Sunday SR,Klump KL,et al. Obsessions and compulsions in anorexia nervosa subtypes.Int J Eat Disord 2003;33:308-19.
[7]Diagnostic and statistical manual of mental disorders,4th ed,:DSM-IV-TR.Washington D.C.: American Psychiatry Association,2000.
[8]SteinerH,Kwan W,Shaffer TQet al.Risk and protective factors for juvanile eating disordes.Eur child Adolesc Psychiatry2003;12:Suppl 1:38-46.
[9]Key A, Lacey H. Progress in eating disorder research[J]. Curr Opin Psychiatry 2002,15(2):143-148.
[10]孙伯民,李殿友,郎黎琴,等.内囊前肢毁损术治疗难治性强迫症.中围神经精神疾病杂志,2003,29：81-83.
[11]Practice guidelines for the treatment of patients with eating disorders(revision):American Psychiatric Association Work Group on Eating Disorders.Am J Psychiatry 2000;157:Suppll:l-39.
[12]Hay P,Bacaltchuk J,Claudino A,et al;Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa.Cochrane Database Syst Rev 2003;4:Cd003909.
[13]Attia E,Haiman C,Walsh BT,et al;Does fluoxetine augment inpatient treatment of anorexia nervosa? Am Jpsychiatry 1998; 155:548-51.
[14]Strober M,Pataki C,Freeman R,et al.No effect of adjunctive fluoxetine on eating behavior or weight phobia during the inpatient of anorexia nervosa:an historical case-control study.J Child Adolesc Psychopharmacol 1999;9:195-201.
[15]Barbarich NC,McConaha CW,Gaskill J,et al.An open trial of olanzapine in anorexia nervosa.J Clin Psychiatry 2004;65:1480-2.
[16]Malina A,Gaskill J,McConha C,et al.Olanzapine treatment of anorexia nervosa:a retrospective study.Int J Eat Disord 2003;33:234-7.
[17]Powers PS,Santana CA,Bannon YS.Olanzapine in the treatment of anorexia nervosa:an open label trial.Int J Eat Disord2002;32:146-54.
[19]吴承瀚,李锋,潘宜新,孙伯民。功能神经外科治疗神经性厌食症的回顾与前瞻,医学综述,2010,16(15),2290-2292.
[20]李轶琛,王继中,马筠。单用西酞普兰与合并家庭治疗对神经性厌食症患者的疗效,上海精神医学,2006,18(3),158-160.
[21]陈玉龙,王霞。米氮平治疗神经性厌食症患者的疗效对照研究,中国心理卫生杂志,2005,19(9),640-642.
[22]Attia E,Kaplan AS,Walsh BT, et al.Olanzapine versus placebo for out-patients with anorexia nervosa, Psychol Med.2011 (22):1-6.
[23]Barbarich NC,Mcconaha CW,Gaskill J,et al.An open trial of olanzapine in anorexia nervosa [J],J clin Psychiatry,2004,65(11):1480-1482.
[24]Boachie A,Goldfield GS,Spetting W, et al.Olanzapine use as an adjunctive treatment for hospitalized children with anrexia nervosa:case report.[J],Int J Eat Disorder,2003,33(1):98-103.
[25]Hansen L,Olanzapine in the treatment of anorexia nervosa [J],Br J Psychiatry.1999,175:592.
[26]周朝昀,陈珏,张冰,张海音,肖泽萍。神经性厌食症患者父母的生命质量研究,四川精神卫生,2009,22(4),209-210.
[1]Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int [J]. Eat Disord 2003,34:383-96.
[2]Urwin RE, Nunn KP. Epistatic interaction between the monoamine oxidase A and serotonin transporter genes in anorexia nervosa. Eur [J]. Hum Genet 2005,13:370-5.
[3]Bulik CM, Sullivan PF, Fear JL, et al.Eating disorders and antecedent anxiety dis-orders:a controlled study. Acta PsychiatrScand,1997,96:101-7.
[4]Halmi KA, Sunday SR, Klump KL, et al.Obsessions and compulsions in anorexia nervosa subtypes. Int [J] Eat Disord,2003,33:308-19.
[5]Godart NT, Flament MF, Curt F, et al.Anxiety disorders in subjects seeking treatment for eating disorders:a DSM-IV controlled study. Psychiatry Res 2003,117:245-58.
[6]Steiner H, Kwan W, Shaffer TQ et al.Risk and protective factors for juvenile eating disorders. Eur Child Adolesc Psychiatry[J],2003,12:Suppl 1:38-46.
[7]Garfinkel PE, Lin E, Goering P, et al.Should amenorrhoea be necessary for the diagnosis of anorexia nervosa? Evidence from a Canadian community sample. [J]Psychiatry,1996,168:500-6.
[8]第8届亚洲功能神经外科大会会议摘要第81页
[9]章晓云,钱铭怡,进食障碍的心理干预[J].中国心理卫生杂志,2004,(18)1：31-34.
[10]Olmsted M.P.,Davis R.,Garner David M.,et al.Efficacy of a brief group psychoeducational intervention for bulimia nervosa[J].Erratum. Behaviour-Research-and-Therapy,1991,29(3):305.
[11]钱铭怡主编,心理治疗,吉林教育出版社,2002年,第173页
[12]Murphy R, Straebler S, Cooper Z, Fairburn CG,et al.Cognitive behavioral therapy for eating disorders[J].Psychiatr Clin North Am.2010,33(3):611-27.
[13]Lock J, Le Grange D, Agras WS,et al.A randomized clinical trial comparing family based treatment to adolescent focused individual therapy for adolescents with anorexia nervosa[J]. Arch Gen Psychiatry,2010,67:1025-1032.
[14]Fitzpatrick K, Moye A, Hostee R, et al. Adolescent focused therapy for adolescent anorexia nervosa[J].Contemp Psychother,2010; 40:31-39.
[15]Robin A, Siegal P, Moye A, et al.A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa[J]. Am Acad Child Adolesc Psychiatry, 1999,38:1482-1489.
[16]Roberto C, Steinglass J, Walsh BT. The clinical significance of amenorrhea as a diagnostic criterion for anorexia nervosa[J]. Eat Disord,2008; 41:559-563.
[17]Brambilla F, Draisci A, Peirone A, et al. Combined cognitive-behavioral,psychopharmacological and nutritional therapy in eating disorders.2. Anorexia nervosa—binge-eating/purging type. Neuropsychobiology,1995,32:64-7.
[18]Gwirtsman HE, Guze BH, Yager J, et al. Fluoxetine treatment of Anorexia Nervosa:an open clinical trial.[J]. Clin Psychiatry,1990,51:378-382.
[19]Fassino S, Leombruni P, Daga G, et al.2002. Efficacy of citalopram in anorexia nervosa: a pilot study[J]. Eur Neuropsychopharmacol,2002,12:453-459.
[20]Holtkamp K, Konrad K, Kaiser N, et al. A retrospective study of SSRI treatment in adolescent anorexia nervosa:insuffi cient evidence for efficacy[J]. Psychiatr Res,2005,39:303-
10.
[21]Walsh BT, Kaplan AS, Attia E, et al. Fluoxetine after weight restoration in anorexia nervosa:a randomized controlled trial[J]. JAMA.,2006,295:2605-2612.
[22]Lacey JH, Crisp AH. Hunger, food intake and weight:the impact of clomipramine on a refeeding anorexia nervosa population[J]. Postgrad Med J,1980,56 (Suppl 1):79-85.
[23]Biederman J, Herzog DB, Rivinus TM, et al. Amitriptyline in the treatment of anorexia ner-vosa:a double-blind, placebo-controlled study[J]. Clin Psychopharmacol,19855:10-6.
[24]Halmi KA, Eckert E, LaDu TJ,et al. Anorexia nervosa. Treatment effi cacy of cyproheptadine and amitriptyline[J]. Arch Gen Psychiatry,1986,43:177-181.
[25]Crisp AH, Lacey JH, Crutchfi eld M. Clomipramine and " Drive " in people with anorexia nervosa:An in-patient study[J]. Br J Psychiatry,1987,150:355-358.
[26]Vandereycken W. Neuroleptics in the short-term treatment of ano-rexia nervosa. A double-blind placebo-controlled study with sulpir-ide. Br J Psychiatry,1984; 144:288-292
[27]Brambilla F, Garcia CS, Fassino S, et al. Olanzapine therapy in anorexia nervosa: psychobiological effects[J]. Int Clin Psychopharmacol.2007;22:197-204
[28]Fisman S, Steele M, Short J, et al. Case study:anorexia nervosa and autistic disorder in an adolescent girl[J]. Am Acad Child Adolesc Psychiatry,1996,35:937-940.
[29]Newman-Toker J. Risperidone in anorexia nervosa.[J]. Am Acad Child Adolesc Psychiatry,2000,39:941-942.
[30]Bosanac P, Kurlender S, Norman T, et al. An open-label study of quetiapine in anorexia nervosa[J]. Hum Psychopharmacol,2007,22:223-230.
[31]Court A, Mulder C, Kerr M, et al. Investigating the effectiveness, safety and tolerability of quetiapine in the treatment of anorexia ner-vosa in young people:a pilot study. [J]. Psychiatr Res,2010,44:1027-34.
[32]Hill K, Bucuvalas J, McClain C, et al. Pilot study of growth hormone administration during the refeeding of malnourished anorexia nervosa patients[J]. Child Adolesc Psychopharmacol.,2000,10:3-8.
[33]Miller KK, Grieco KA, Klibanski A. Testosterone administration in women with anorexia nervosa[J]. Clin Endocrinol Metab.,2005,90:1428-1433.
[34]Lim, L. A., McGovern, L., Elamin, M. B,et al.Effect on bone health of estrogen preparations in premenopausal women with anorexia nervosa:A systematic review and meta-analyses[J].International Journal of Eating Disorders,2010,43,218-225.
[35]Mehler, P. S., MacKenzie, T. D.aTreatment of osteopenia and osteoporosis in anorexia nervosa:a systematic review of the literature[J]. International Journal of Eating Disorders, 2009,42:195-201.
[36]Taveggia C, Thaker P, Petrylak A, et al. Type III neuregulin-1 promotes oligodendrocyte myelination[J]. Glia,2008,56(3):284-93.
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