CBT和藥物對暴飲暴食症有幫助


  【24drs.com】一篇新的系統性文獻回顧與統合分析的作者們結論指出,針對暴飲暴食症(BED)已有有效治療。
  
  這篇回顧發現,治療師引導的認知行為治療(CBT)、興奮劑lisdexamfetamine (商品名Vyvanse, Shire藥廠)、第二代抗憂鬱劑(SGAs)以及topiramate (有多種商品)可幫助減輕暴飲暴食及相關精神病理症狀。Lisdexamfetamine和topiramate也可減輕BED成年患者的體重。去年,lisdexamfetamine成為第一個獲得美國食品藥物管理局核准的BED治療用藥。
  
  自2013年起,美國精神病學協會正式將BED視為一種診斷,對BED掀起了風起雲湧般的注意與興趣,第一作者、北卡羅來納大學教堂山分校飲食異常精進中心副教授Kim Brownley博士表示,包括患者與開業醫師對各方面的認識與服務需求,所以,現在似乎是更新我們對現有最佳治療之瞭解的時機。
  
  本研究線上發表於6月28日內科醫學誌。
  
  BED是美國最常見的飲食異常,影響約3%的美國人,BED的特徵是復發導致心理痛苦的暴食現象,發作時患者會失控地攝取遠多於一般人在類似情況下的飲食量。
  
  這篇新回顧更新且擴展了一篇2006年有關飲食異常,檢視34篇治療BED之隨機控制試驗的回顧,9篇試驗聚焦在心理治療,25篇聚焦在藥物;研究者表示,本次回顧的文獻幾乎是前次的2倍之多。
  
  作者們報告指出,治療師引導的CBT相較於等待名單(58.8% vs 11.2%;相對風險[RR], 4.95;95%信賴區間[CI], 3.06 - 8.00)、lisdexamfetamine相較於安慰劑(40.2% vs 14.9%;RR, 2.61;95% CI, 2.04 - 3.33)以及 SGAs相較於安慰劑(39.9% vs 23.6%;RR, 1.67;95% CI, 1.24 - 2.26),更多參與者達到從暴飲暴食禁慾。
  
  Lisdexamfetamine和SGAs這一類也減少了與暴飲暴食有關的強迫觀念和強迫行為,SGAs也可減輕憂鬱症狀。Topiramate減輕體重和增加交感神經系統興奮,lisdexamfetamine降低食慾與體重。相較於安慰劑,頭痛、腸胃不適、睡眠障礙、交感神經系統興奮是lisdexamfetamine比較常見的副作用(RR範圍:1.63 - 4.28)。
  
  Brownley博士表示,CBT、lisdexamfetamine和SGAs在降低暴飲暴食頻率的效果上,展現出最佳證據,在某些案例中,達到從暴飲暴食禁慾的狀態,並減少暴飲暴食隨之而來的心理壓力。
  
  研究者指出,大部份研究對象是20-40歲的過重或肥胖白人女性,許多治療只在單一研究中探討,各篇研究對結果之測量不一致,治療結束之後的評估很少。
  
  Brownley博士表示,需要更多暴飲暴食的研究是明確的,她解釋,相較於我們知道的,這篇[回顧]告訴我們更多我們所不知道的,舉例來說,我們不知道這些治療方式結束之後的長期效果,我們無法說這三種治療中的哪一種顯著優於其他兩種,因為沒有對等性比較研究。
  
  Brownley博士指出,我認為,多數患者和醫師會有的一個問題是,要從哪種治療方法開始。這種會優於其他種方法嗎?我們現在還無法回答這個問題。
  
  紐約市紐約州精神病研究所Michael Devlin醫師在關聯評論指出,因為患者對BED感到羞恥,要察覺它可能會是個挑戰。
  
  他表示,BED很容易被忽視,因為患者往往認為這是個人的失敗而非應與醫師討論的疾病。所以,如果醫師沒有特別問,患者可能也不會提到它。體重頻繁大幅波動者,特別是有憂鬱症狀且對體重和外型有明顯關注者,應詢問其有關暴飲暴食情況,並於有需要時提供治療選項。
  
  Devlin醫師表示,這篇回顧確實有幫助,且極佳地總結了暴飲暴食症之治療的最新療法。
  
  資料來源:http://www.24drs.com/
  
  Native link:CBT, Medication Helpful for Binge Eating Disorder

CBT, Medication Helpful for Binge Eating Disorder

By Megan Brooks
Medscape Medical News

Effective treatments are available for binge eating disorder (BED), conclude the authors of a new systematic literature review and meta-analysis.

Therapist-led cognitive-behavioral therapy (CBT), the stimulant lisdexamfetamine (Vyvanse, Shire), second-generation antidepressants (SGAs), and topiramate (multiple brands) help reduce binge eating and related psychopathology, the review found. Lisdexamfetamine and topiramate also reduce weight in adults with BED. Last year, lisdexamfetamine became the first medication approved by the US Food and Drug Administration for the treatment of patients with BED.

Since 2013, when the American Psychiatric Association officially recognized BED as a diagnosis, there has been a "ground swell" in attention and interest in BED "at all levels in terms of patient and practitioner awareness and demand for services, and so it seemed like it was time to update our understanding of best treatments available," lead author Kim Brownley, PhD, associate professor, University of North Carolina Center of Excellence for Eating Disorders, in Chapel Hill, told Medscape Medical News.

The study was published online June 28 in Annals of Internal Medicine.

Distressing Disorder

BED is the most common eating disorder in the United States, affecting about 3% of the US population. BED is characterized by recurrent psychologically distressing binge-eating episodes, during which individuals experience a lack of control and consume larger amounts of food than most people would under similar circumstances.

The new review updates and extends a 2006 review on eating disorders by examining 34 randomized controlled trials of treatments for BED. Nine trials focused on psychological treatment, and 25 focused on medication. This is nearly twice as many trials as in the earlier review, the researchers note.

More participants achieved abstinence from binge eating with therapist-led CBT vs wait list (58.8% vs 11.2%; relative risk [RR], 4.95; 95% confidence interval [CI], 3.06 - 8.00), with lisdexamfetamine vs placebo (40.2% vs 14.9%; RR, 2.61; 95% CI, 2.04 - 3.33), and with SGAs vs placebo (39.9% vs 23.6%; RR, 1.67; 95% CI, 1.24 - 2.26), the authors report.

Lisdexamfetamine and SGAs as a class also reduced binge eating–related obsessions and compulsions, and SGAs reduced depressive symptoms. Topiramate reduced weight and increased sympathetic nervous system arousal, and lisdexamfetamine reduced appetite and weight. Headache, gastrointestinal upset, sleep disturbance, and sympathetic nervous system arousal were more common with lisdexamfetamine than with placebo (RR range, 1.63 - 4.28).

CBT, lisdexamfetamine, and SGAs "bubble to the top as having the most evidence for effectiveness in reducing binge frequency and in some cases reaching a state of abstinence from binge eating and reducing the psychological distress that comes along with binge eating," Dr Brownley told Medscape Medical News.

The researchers note that most of the study participants were overweight or obese white women aged 20 to 40 years. Many treatments were examined only in single studies, and outcomes were measured "inconsistently" across trials and were rarely evaluated beyond end of treatment.

There "clearly" is a need for more research in binge eating, Dr Brownley said. "This [review] probably shows us more about what we don't know than what we do know. For example, we don't know the long-term effectiveness of these treatments after they end. We cannot say whether any one of these three treatments is significantly better than any of the others because there have been no head-to-head trials," she explained.

"One question I think a lot of patients and practitioners will have is which treatment to start with. Is one likely to be better than another? That's a question we just can't answer at this point," Dr Brownley added.

Detection Challenging

In a linked editorial, Michael Devlin, MD, of the New York State Psychiatric Institute, in New York City, notes that because BED is a source of shame for those affected, it may be challenging to detect.

"BED can easily be overlooked, as patients often view it as a personal failing rather than an illness that they might discuss with their doctor," he told Medscape Medical News. "So if the doctor does not ask specifically, the patient may well not bring it up. Individuals with frequent large fluctuations in weight, especially with depressive symptoms and pronounced concern with weight and shape, should be asked about binge eating and offered options for treatment if it is occurring," he advised.

"The review is indeed helpful and an excellent summary of the state of the art with regard to treatment for binge eating disorder," Dr Devlin said.

The study was funded by the Agency for Healthcare Research and Quality. Dr Brownley has received personal fees from Shire and Sunovion Pharmaceuticals outside the submitted work. Dr Devlin reports no relevant financial relationships.

Ann Intern Med. Published online June 28, 2016.

    
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