中国神经性厌食症诊疗专家共识

doi:10.12114/j.issn.1007-9572.2023.0728

中国全科医学 ›› 2024, Vol. 27 ›› Issue (05): 509-520.DOI: 10.12114/j.issn.1007-9572.2023.0728

中国神经性厌食症诊疗专家共识

中华医学会心身医学分会进食障碍协作学组, 中华医学会精神医学分会进食障碍研究协作组, 陈涵¹, 陈妍¹, 韩慧琴¹, 李雪霓², 张岚³, 孔庆梅², 乔慧芬⁴, 匡桂芳⁵, 孙建琴⁶, 虞阳⁶, 金富锐⁷, 蒋晶晶⁸, 张大荣², 栗克清⁹, 王振¹^,^*(), 陈珏¹^,^*()

1．200030　上海市，上海交通大学医学院附属精神卫生中心
2．100091　北京市，北京大学第六医院　北京大学精神卫生研究所　国家卫生健康委员会精神卫生学重点实验室（北京大学）　国家精神心理疾病临床医学研究中心（北京大学第六医院）
3．610041　四川省成都市，四川大学华西医院心理卫生中心
4．210024　江苏省南京市，南京医科大学附属脑科医院
5．266034　山东省青岛市，青岛大学附属妇女儿童医院
6．200040　上海市，复旦大学附属华东医院
7．200030　上海市，中国福利会国际和平妇幼保健院
8．200032　上海市，复旦大学附属中山医院
9．071000　河北省保定市，河北省精神卫生中心

收稿日期:2023-08-10 修回日期:2023-10-25 出版日期:2024-02-15 发布日期:2023-11-21
通讯作者: 王振, 陈珏
基金资助:
国家自然科学基金项目面上项目(82071545); 上海市科学技术委员会医学创新研究专项项目(20Y11906500); 上海市卫生健康委员会面上项目(202140092); 医工交叉重点项目(YG2022ZD026); 上海市精神心理疾病临床医学研究中心(19MC1911100)

Chinese Expert Consensus on the Diagnosis and Treatment of Anorexia Nervosa

Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, CHEN Han¹, CHEN Yan¹, HAN Huiqin¹, LI Xueni², ZHANG Lan³, KONG Qingmei², QIAO Huifen⁴, KUANG Guifang⁵, SUN Jianqin⁶, YU Yang⁶, JIN Furui⁷, JIANG Jingjing⁸, ZHANG Darong², LI Keqing⁹, WANG Zhen¹^,^*(), CHEN Jue¹^,^*()

1. Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
2. Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100091, China
3. Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
4. Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210024, China
5. Women and Children's Hospital, Qingdao University, Qingdao 266034, China
6. Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
7. International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai 200030, China
8. Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
9. Hebei Mental Health Center, Baoding 071000, China

Received:2023-08-10 Revised:2023-10-25 Published:2024-02-15 Online:2023-11-21
Contact: WANG Zhen, CHEN Jue

摘要/Abstract

摘要： 神经性厌食症是以自我饥饿、体质量显著减轻和营养不良为特征的一类进食障碍。在所有精神疾病中，神经性厌食症死亡率最高，其会导致严重的精神病理症状和危及生命的医疗并发症。然而，目前在中国，对于神经性厌食症不能早期识别和诊治，导致病程迁延。因此，在中华医学会心身医学分会进食障碍协作学组的组织下，联合中华医学会精神医学分会进食障碍研究协作组，由16名医学专家基于循证医学证据、国内外指南与专家共识、专家经验等制定本专家共识，以期提高国内专业人员对神经性厌食症的识别和诊治水平。

关键词: 神经性厌食, 营养治疗, 心理治疗, 药物治疗, 专家共识

Abstract:

Anorexia nervosa (AN) is a type of eating disorders characterized by self-starvation, significant loss of body mass, and malnutrition. AN has the highest mortality rate among all psychiatric disorders, leading to severe psychopathologic symptoms and life-threatening medical complications. However, AN cannot be recognized and diagnosed early in China, resulting in a prolonged course of the disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, together with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, this expert consensus was formulated by 16 medical experts based on evidence-based medical evidence, domestic and international guidelines and expert consensus, expert experience, etc., in order to improve the recognition, diagnosis and treatment of AN among domestic professionals.

Key words: Anorexia nervosa, Nutrition therapy, Psychotherapy, Pharmacotherapy, Expert consensus

中华医学会心身医学分会进食障碍协作学组,中华医学会精神医学分会进食障碍研究协作组,陈涵,等. 中国神经性厌食症诊疗专家共识[J]. 中国全科医学, 2024, 27(05): 509-520. DOI: 10.12114/j.issn.1007-9572.2023.0728.
Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association,Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association,CHEN Han, et al. Chinese Expert Consensus on the Diagnosis and Treatment of Anorexia Nervosa[J]. Chinese General Practice, 2024, 27(05): 509-520. DOI: 10.12114/j.issn.1007-9572.2023.0728.

图/表 5

参考文献 95

[1]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders，fifth edition，text revision[M]. Washington：American Psychiatric Association，2022.
[2]	王向群，王高华. 中国进食障碍防治指南[M]. 北京：中华医学电子音像出版社，2015.
[3]	陈珏. 进食障碍[M]. 北京：人民卫生出版社，2013.
[4]	TREASURE J, DUARTE T A, SCHMIDT U. Eating disorders[J]. Lancet，2020,395(10227):899-911. DOI：10.1016/S0140-6736(20)30059-3.
[5]	高一鸣，陈珏. 进食障碍发病危险因素的研究进展[J]. 上海交通大学学报（医学版），2019,39(4):432-435. DOI：10.3969/j.issn.1674-8115.2019.04.019
[6]	SULLIVAN P F. Mortality in anorexia nervosa[J]. Am J Psychiatry，1995,152(7):1073-1074. DOI：10.1176/ajp.152.7.1073.
[7]	HERZOG D B, NUSSBAUM K M, MARMOR A K. Comorbidity and outcome in eating disorders[J]. Psychiatr Clin North Am，1996,19(4):843-859. DOI：10.1016/s0193-953x(05)70385-3.
[8]	HERUC G, HURST K, CASEY A，et al. ANZAED eating disorder treatment principles and general clinical practice and training standards[J]. J Eat Disord，2020,8(1):63. DOI：10.1186/s40337-020-00341-0.
[9]	TREASURE J, RUSSELL G. The case for early intervention in anorexia nervosa：theoretical exploration of maintaining factors[J]. Br J Psychiatry，2011,199(1):5-7. DOI：10.1192/bjp.bp.110.087585.
[10]	Scottish Intercollegiate Guidelines Network（SIGN）. Eating disorders 2022[EB/OL].[2023-07-15].
[11]	LOCK J, LA VIA M C, American Academy of Child and Adolescent Psychiatry（AACAP） Committee on Quality Issues（CQI）. Practice parameter for the assessment and treatment of children and adolescents with eating disorders[J]. J Am Acad Child Adolesc Psychiatry，2015,54(5):412-425. DOI：10.1016/j.jaac.2015.01.018.
[12]	National Guideline Alliance（UK）. Eating disorders：recognition and treatment[M]. London：National Institute for Health and Care Excellence（NICE），2017.
[13]	HORNBERGER L L, LANE M A, Committee on Adolescence. Identification and management of eating disorders in children and adolescents[J]. Pediatrics，2021,147(1):e2020040279. DOI：10.1542/peds.2020-040279.
[14]	DA SILVA J S V, SERES D S, SABINO K，et al. ASPEN consensus recommendations for refeeding syndrome[J]. Nutr Clin Pract，2020,35(2):178-195. DOI：10.1002/ncp.10474.
[15]	FRIEDLI N, STANGA Z, SOBOTKA L，et al. Revisiting the refeeding syndrome：results of a systematic review[J]. Nutrition，2017,35:151-160. DOI：10.1016/j.nut.2016.05.016.
[16]	Society for Adolescent Health and Medicine, GOLDEN N H, KATZMAN D K，et al. Position Paper of the Society for Adolescent Health and Medicine：medical management of restrictive eating disorders in adolescents and young adults[J]. J Adolesc Health，2015,56(1):121-125. DOI：10.1016/j.jadohealth.2014.10.259.
[17]	O'CONNOR G, NICHOLLS D, HUDSON L，et al. Refeeding low weight hospitalized adolescents with anorexia nervosa：a multicenter randomized controlled trial[J]. Nutr Clin Pract，2016,31(5):681-689. DOI：10.1177/0884533615627267.
[18]	HALE M D, LOGOMARSINO J V. The use of enteral nutrition in the treatment of eating disorders：a systematic review[J]. Eat Weight Disord，2019,24(2):179-198. DOI：10.1007/s40519-018-0572-4.
[19]	MARIKAR D, REYNOLDS S, MOGHRABY O S. Junior MARSIPAN （management of really sick patients with anorexia nervosa）：table 1[J]. Arch Dis Child Educ Pract Ed，2016,101(3):140-143. DOI：10.1136/archdischild-2015-308679.
[20]	BERENDS T, BOONSTRA N, VAN ELBURG A. Relapse in anorexia nervosa：a systematic review and meta-analysis[J]. Curr Opin Psychiatry，2018,31(6):445-455. DOI：10.1097/YCO.0000000000000453.
[21]	WILD B, FRIEDERICH H C, ZIPFEL S，et al. Predictors of outcomes in outpatients with anorexia nervosa-results from the ANTOP study[J]. Psychiatry Res，2016,244:45-50. DOI：10.1016/j.psychres.2016.07.002.
[22]	KAPLAN A S, WALSH B T, OLMSTED M，et al. The slippery slope：prediction of successful weight maintenance in anorexia nervosa[J]. Psychol Med，2009,39(6):1037-1045. DOI：10.1017/S003329170800442X.
[23]	GOLDEN N H, KEANE-MILLER C, SAINANI K L，et al. Higher caloric intake in hospitalized adolescents with anorexia nervosa is associated with reduced length of stay and no increased rate of refeeding syndrome[J]. J Adolesc Health，2013,53(5):573-578. DOI：10.1016/j.jadohealth.2013.05.014.
[24]	SMITH K, LESSER J, BRANDENBURG B，et al. Outcomes of an inpatient refeeding protocol in youth with Anorexia Nervosa and atypical Anorexia Nervosa at Children's Hospitals and Clinics of Minnesota[J]. J Eat Disord，2016,4:35. DOI：10.1186/s40337-016-0124-0.
[25]	PARKER E K, FARUQUIE S S, ANDERSON G，et al. Higher caloric refeeding is safe in hospitalised adolescent patients with restrictive eating disorders[J]. J Nutr Metab，2016,2016:5168978. DOI：10.1155/2016/5168978.
[26]	GARBER A K, SAWYER S M, GOLDEN N H，et al. A systematic review of approaches to refeeding in patients with anorexia nervosa[J]. Int J Eat Disord，2016,49(3):293-310. DOI：10.1002/eat.22482.
[27]	HARRINGTON B C, JIMERSON M, HAXTON C，et al. Initial evaluation，diagnosis，and treatment of anorexia nervosa and bulimia nervosa[J]. Am Fam Physician，2015,91(1):46-52.
[28]	XIONG R Q, HUANG H, WU Y M，et al. Incidence and outcome of refeeding syndrome in neurocritically ill patients[J]. Clin Nutr，2021,40(3):1071-1076. DOI：10.1016/j.clnu.2020.06.038.
[29]	SILVA A D, SMITH T, STROUD M. Attitudes to NICE guidance on refeeding syndrome[J]. BMJ，2008,337(jul08 2):a680. DOI：10.1136/bmj.a680.
[30]	GIBSON D, WATTERS A, MEHLER P S. The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder：functional or pathophysiologic? -a systematic review[J]. Int J Eat Disord，2021,54(6):1019-1054. DOI：10.1002/eat.23553.
[31]	MALEC M, SHEGA J W. Management of gastrointestinal symptoms （nausea，anorexia and cachexia，constipation） in advanced illness[J]. Med Clin North Am，2020,104(3):439-454. DOI：10.1016/j.mcna.2019.12.005.
[32]	WARREN M P. Endocrine manifestations of eating disorders[J]. J Clin Endocrinol Metab，2011,96(2):333-343. DOI：10.1210/jc.2009-2304.
[33]	MISRA M, GOLDEN N H, KATZMAN D K. State of the art systematic review of bone disease in anorexia nervosa[J]. Int J Eat Disord，2016,49(3):276-292. DOI：10.1002/eat.22451.
[34]	MISRA M. Long-term skeletal effects of eating disorders with onset in adolescence[J]. Ann N Y Acad Sci，2008,1135:212-218. DOI：10.1196/annals.1429.002.
[35]	SCHORR M, MILLER K K. The endocrine manifestations of anorexia nervosa：mechanisms and management[J]. Nat Rev Endocrinol，2017,13(3):174-186. DOI：10.1038/nrendo.2016.175.
[36]	CHOU S H, MANTZOROS C. Bone metabolism in anorexia nervosa and hypothalamic amenorrhea[J]. Metabolism，2018,80:91-104. DOI：10.1016/j.metabol.2017.10.009.
[37]	FRISCH R E, MCARTHUR J W. Menstrual cycles：fatness as a determinant of minimum weight for height necessary for their maintenance or onset[J]. Science，1974,185(4155):949-951. DOI：10.1126/science.185.4155.949.
[38]	VYVER E, STEINEGGER C, KATZMAN D K. Eating disorders and menstrual dysfunction in adolescents[J]. Ann N Y Acad Sci，2008,1135:253-264. DOI：10.1196/annals.1429.013.
[39]	COUTURIER J, ISSERLIN L, NORRIS M，et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders[J]. J Eat Disord，2020,8:4. DOI：10.1186/s40337-020-0277-8.
[40]	JEWELL T, BLESSITT E, STEWART C，et al. Family therapy for child and adolescent eating disorders：a critical review[J]. Fam Process，2016,55(3):577-594. DOI：10.1111/famp.12242.
[41]	FISHER C A, SKOCIC S, RUTHERFORD K A，et al. Family therapy approaches for anorexia nervosa[J]. Cochrane Database Syst Rev，2019,5:CD004780. DOI：10.1002/14651858.CD004780.pub4.
[42]	ZEECK A, HERPERTZ-DAHLMANN B, FRIEDERICH H C，et al. Psychotherapeutic treatment for anorexia nervosa：a systematic review and network meta-analysis[J]. Front Psychiatry，2018,9:158. DOI：10.3389/fpsyt.2018.00158.
[43]	RICHARDS I L, SUBAR A, TOUYZ S，et al. Augmentative approaches in family-based treatment for adolescents with restrictive eating disorders：a systematic review[J]. Eur Eat Disord Rev，2018,26(2):92-111. DOI：10.1002/erv.2577.
[44]	MYSLIWIEC R. Neuroscience of adolescent anorexia nervosa：implications for family-based treatment （FBT）[J]. Front Psychiatry，2020,11:418. DOI：10.3389/fpsyt.2020.00418.
[45]	FORSBERG S, LOCK J. Family-based treatment of child and adolescent eating disorders[J]. Child Adolesc Psychiatr Clin N Am，2015,24(3):617-629. DOI：10.1016/j.chc.2015.02.012.
[46]	LOCK J, LE GRANGE D, AGRAS W S，et al. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa[J]. Arch Gen Psychiatry，2010,67(10):1025-1032. DOI：10.1001/archgenpsychiatry.2010.128.
[47]	LE GRANGE D, ACCURSO E C, LOCK J，et al. Early weight gain predicts outcome in two treatments for adolescent anorexia nervosa[J]. Int J Eat Disord，2014,47(2):124-129. DOI：10.1002/eat.22221.
[48]	CIAO A C, ACCURSO E C, FITZSIMMONS-CRAFT E E，et al. Family functioning in two treatments for adolescent anorexia nervosa[J]. Int J Eat Disord，2015,48(1):81-90. DOI：10.1002/eat.22314.
[49]	MATTHEWS A, PETERSON C M, PEUGH J，et al. An intensive family-based treatment guided intervention for medically hospitalized youth with anorexia nervosa：parental self-efficacy and weight-related outcomes[J]. Eur Eat Disord Rev，2019,27(1):67-75. DOI：10.1002/erv.2632.
[50]	CALUGI S, DALLE GRAVE R, SARTIRANA M，et al. Time to restore body weight in adults and adolescents receiving cognitive behaviour therapy for anorexia nervosa[J]. J Eat Disord，2015,3:21. DOI：10.1186/s40337-015-0057-z.
[51]	DALLE GRAVE R, CALUGI S, EL GHOCH M，et al. Inpatient cognitive behavior therapy for adolescents with anorexia nervosa：immediate and longer-term effects[J]. Front Psychiatry，2014,5:14. DOI：10.3389/fpsyt.2014.00014.
[52]	DALLE GRAVE R, SARTIRANA M, CALUGI S. Enhanced cognitive behavioral therapy for adolescents with anorexia nervosa：outcomes and predictors of change in a real-world setting[J]. Int J Eat Disord，2019,52(9):1042-1046. DOI：10.1002/eat.23122.
[53]	DALLE GRAVE R, CALUGI S, DOLL H A，et al. Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa：an alternative to family therapy?[J]. Behav Res Ther，2013,51(1):R9-12. DOI：10.1016/j.brat.2012.09.008.
[54]	BALL J, MITCHELL P. A randomized controlled study of cognitive behavior therapy and behavioral family therapy for anorexia nervosa patients[J]. Eat Disord，2004,12(4):303-314. DOI：10.1080/10640260490521389.
[55]	VOGEL E N, SINGH S, ACCURSO E C. A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders[J]. J Eat Disord，2021,9(1):131. DOI：10.1186/s40337-021-00461-1.
[56]	张靖，陈珏. 辩证行为疗法在进食障碍中的应用[J]. 精神医学杂志，2018,31(4):312-315. DOI：10.3969/j.issn.2095-9346.2018.04.020
[57]	BANKOFF S M, KARPEL M G, FORBES H E，et al. A systematic review of dialectical behavior therapy for the treatment of eating disorders[J]. Eat Disord，2012,20(3):196-215. DOI：10.1080/10640266.2012.668478.
[58]	SALBACH-ANDRAE H, BOHNEKAMP I, PFEIFFER E，et al. Dialectical behavior therapy of anorexia and bulimia nervosa among adolescents：a case series[J]. Cogn Behav Pract，2008,15(4):415-425. DOI：10.1016/j.cbpra.2008.04.001.
[59]	ACCURSO E C, ASTRACHAN-FLETCHER E, O'BRIEN S，et al. Adaptation and implementation of family-based treatment enhanced with dialectical behavior therapy skills for anorexia nervosa in community-based specialist clinics[J]. Eat Disord，2018,26(2):149-163. DOI：10.1080/10640266.2017.1330319.
[60]	VAN DEN BERG E, HOUTZAGER L, DE VOS J，et al. Meta-analysis on the efficacy of psychological treatments for anorexia nervosa[J]. Eur Eat Disord Rev，2019,27(4):331-351. DOI：10.1002/erv.2683.
[61]	JANSINGH A, DANNER U N, HOEK H W，et al. Developments in the psychological treatment of anorexia nervosa and their implications for daily practice[J]. Curr Opin Psychiatry，2020,33(6):534-541. DOI：10.1097/YCO.0000000000000642.
[62]	GALLETLY C, CASTLE D, DARK F，et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders[J]. Aust N Z J Psychiatry，2016,50(5):410-472. DOI：10.1177/0004867416641195.
[63]	LINARDON J, FAIRBURN C G, FITZSIMMONS-CRAFT E E，et al. The empirical status of the third-wave behaviour therapies for the treatment of eating disorders：a systematic review[J]. Clin Psychol Rev，2017,58:125-140. DOI：10.1016/j.cpr.2017.10.005.
[64]	GALSWORTHY-FRANCIS L, ALLAN S. Cognitive Behavioural Therapy for anorexia nervosa：a systematic review[J]. Clin Psychol Rev，2014,34(1):54-72. DOI：10.1016/j.cpr.2013.11.001.
[65]	BYRNE S, WADE T, HAY P，et al. A randomised controlled trial of three psychological treatments for anorexia nervosa[J]. Psychol Med，2017,47(16):2823-2833. DOI：10.1017/S0033291717001349.
[66]	ATWOOD M E, FRIEDMAN A. A systematic review of enhanced cognitive behavioral therapy （CBT-E） for eating disorders[J]. Int J Eat Disord，2020,53(3):311-330. DOI：10.1002/eat.23206.
[67]	ZIPFEL S, WILD B, GROß G，et al. Focal psychodynamic therapy，cognitive behaviour therapy，and optimised treatment as usual in outpatients with anorexia nervosa （ANTOP study）：randomised controlled trial[J]. Lancet，2014,383(9912):127-137. DOI：10.1016/S0140-6736(13)61746-8.
[68]	ABBATE-DAGA G, MARZOLA E, AMIANTO F，et al. A comprehensive review of psychodynamic treatments for eating disorders[J]. Eat Weight Disord，2016,21(4):553-580. DOI：10.1007/s40519-016-0265-9.
[69]	HAY P J, CLAUDINO A M, TOUYZ S，et al. Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa[J]. Cochrane Database Syst Rev，2015,2015(7):CD003909. DOI：10.1002/14651858.CD003909.pub2.
[70]	NAVARRO-HARO M V, BOTELLA C, GUILLEN V，et al. Dialectical behavior therapy in the treatment of borderline personality disorder and eating disorders comorbidity：a pilot study in a naturalistic setting[J]. Cogn Ther Res，2018,42(5):636-649. DOI：10.1007/s10608-018-9906-9.
[71]	LYNCH T R, GRAY K L, HEMPEL R J，et al. Radically open-dialectical behavior therapy for adult anorexia nervosa：feasibility and outcomes from an inpatient program[J]. BMC Psychiatry，2013,13:293. DOI：10.1186/1471-244X-13-293.
[72]	CARTER F A, JORDAN J, MCINTOSH V V，et al. The long-term efficacy of three psychotherapies for anorexia nervosa：a randomized，controlled trial[J]. Int J Eat Disord，2011,44(7):647-654. DOI：10.1002/eat.20879.
[73]	MCINTOSH V V, JORDAN J, CARTER F A，et al. Three psychotherapies for anorexia nervosa：a randomized，controlled trial[J]. Am J Psychiatry，2005,162(4):741-747. DOI：10.1176/appi.ajp.162.4.741.
[74]	MONTELEONE A M, PELLEGRINO F, CROATTO G，et al. Treatment of eating disorders：a systematic meta-review of meta-analyses and network meta-analyses[J]. Neurosci Biobehav Rev，2022,142:104857. DOI：10.1016/j.neubiorev.2022.104857.
[75]	BALESTRIERI M, ORIANI M G, SIMONCINI A，et al. Psychotropic drug treatment in anorexia nervosa. Search for differences in efficacy/tolerability between adolescent and mixed-age population[J]. Eur Eat Disord Rev，2013,21(5):361-373. DOI：10.1002/erv.2240.
[76]	MONGE M C, FORMAN S F, MCKENZIE N M，et al. Use of psychopharmacologic medications in adolescents with restrictive eating disorders：analysis of data from the national eating disorder quality improvement collaborative[J]. J Adolesc Health，2015,57(1):66-72. DOI：10.1016/j.jadohealth.2015.03.021.
[77]	BLANCHET C, GUILLAUME S, BAT-PITAULT F，et al. Medication in AN：a multidisciplinary overview of meta-analyses and systematic reviews[J]. J Clin Med，2019,8(2):278. DOI：10.3390/jcm8020278.
[78]	RESMARK G, HERPERTZ S, HERPERTZ-DAHLMANN B，et al. Treatment of anorexia nervosa-new evidence-based guidelines[J]. J Clin Med，2019,8(2):153. DOI：10.3390/jcm8020153.
[79]	MARVANOVA M, GRAMITH K. Role of antidepressants in the treatment of adults with anorexia nervosa[J]. Ment Health Clin，2018,8(3):127-137. DOI：10.9740/mhc.2018.05.127.
[80]	FRANK G K, SHOTT M E. The role of psychotropic medications in the management of anorexia nervosa：rationale，evidence and future prospects[J]. CNS Drugs，2016,30(5):419-442. DOI：10.1007/s40263-016-0335-6.
[81]	MURATORE A F, ATTIA E. Current therapeutic approaches to anorexia nervosa：state of the art[J]. Clin Ther，2021,43(1):85-94. DOI：10.1016/j.clinthera.2020.11.006.
[82]	BRAMBILLA F, GARCIA C S, FASSINO S，et al. Olanzapine therapy in anorexia nervosa：psychobiological effects[J]. Int Clin Psychopharmacol，2007,22(4):197-204. DOI：10.1097/YIC.0b013e328080ca31.
[83]	BISSADA H, TASCA G A, BARBER A M，et al. Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa：a randomized，double-blind，placebo-controlled trial[J]. Am J Psychiatry，2008,165(10):1281-1288. DOI：10.1176/appi.ajp.2008.07121900.
[84]	DOLD M, AIGNER M, KLABUNDE M，et al. Second-generation antipsychotic drugs in anorexia nervosa：a meta-analysis of randomized controlled trials[J]. Psychother Psychosom，2015,84(2):110-116. DOI：10.1159/000369978.
[85]	ATTIA E, STEINGLASS J E, WALSH B T，et al. Olanzapine versus placebo in adult outpatients with anorexia nervosa：a randomized clinical trial[J]. Am J Psychiatry，2019,176(6):449-456. DOI：10.1176/appi.ajp.2018.18101125.
[86]	SPETTIGUE W, NORRIS M L, MARAS D，et al. Evaluation of the effectiveness and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescents：an open-label trial[J]. J De L'academie Can De Psychiatr De L'enfant De L'adolescent，2018,27(3):197-208. DOI：10.3109/15622975.2011.602720.
[87]	STEINGLASS J E, KAPLAN S C, LIU Y，et al. The （lack of） effect of alprazolam on eating behavior in anorexia nervosa：a preliminary report[J]. Int J Eat Disord，2014,47(8):901-904. DOI：10.1002/eat.22343.
[88]	MINIATI M, MAURI M, CIBERTI A，et al. Psychopharmacological options for adult patients with anorexia nervosa[J]. CNS Spectr，2016,21(2):134-142. DOI：10.1017/S1092852914000790.
[89]	MURATORE A F, ATTIA E. Psychopharmacologic management of eating disorders[J]. Curr Psychiatry Rep，2022,24(7):345-351. DOI：10.1007/s11920-022-01340-5.
[90]	何欠欠，陈珏. 进食障碍患者情绪调节异常的神经机制[J]. 中华行为医学与脑科学杂志，2021,30(12):1147-1152. DOI：10.3760/cma.j.cn371468-20210728-00425.
[91]	LIPSMAN N, WOODSIDE D B, LOZANO A M. Neurocircuitry of limbic dysfunction in anorexia nervosa[J]. Cortex，2015,62:109-118. DOI：10.1016/j.cortex.2014.02.020.
[92]	DALTON B, BARTHOLDY S, MCCLELLAND J，et al. Randomised controlled feasibility trial of real versus sham repetitive transcranial magnetic stimulation treatment in adults with severe and enduring anorexia nervosa：the TIARA study[J]. BMJ Open，2018,8(7):e021531. DOI：10.1136/bmjopen-2018-021531.
[93]	DALTON B, LEWIS Y D, BARTHOLDY S，et al. Repetitive transcranial magnetic stimulation treatment in severe，enduring anorexia nervosa：an open longer-term follow-up[J]. Eur Eat Disord Rev，2020,28(6):773-781. DOI：10.1002/erv.2766.
[94]	BODELL L P, KEEL P K. Current treatment for anorexia nervosa：efficacy，safety，and adherence[J]. Psychol Res Behav Manag，2010,3:91-108. DOI：10.2147/PRBM.S13814.
[95]	陈妍，陈珏. 神经调控技术在进食障碍中的应用[J]. 中华行为医学与脑科学杂志，2021,30(5):469-475. DOI：10.3760/cma.j.cn371468-20210104-00019.

推荐强度	证据级别	病因、治疗、预防
A	1a	多个同质随机对照研究的系统综述
	1b	单个随机对照研究
	1c	"全或无"证据
B	2a	同质性队列研究的系统综述
	2b	单一的队列研究（包括低质量的随机对照研究，如随访率<80%）
	2c	结局性研究
	3a	同质性病例对照研究的系统综述
	3b	单独的病例对照研究
C	4	病例系列
D	5	没有严格评价的专家意见，或完全基于生理学和基础研究

推荐强度	证据级别	病因、治疗、预防
A	1a	多个同质随机对照研究的系统综述
	1b	单个随机对照研究
	1c	"全或无"证据
B	2a	同质性队列研究的系统综述
	2b	单一的队列研究（包括低质量的随机对照研究，如随访率<80%）
	2c	结局性研究
	3a	同质性病例对照研究的系统综述
	3b	单独的病例对照研究
C	4	病例系列
D	5	没有严格评价的专家意见，或完全基于生理学和基础研究

分类	躯体症状
营养不良：与能量摄入不足有关的特征	在身高、体质量和体质量指数图表上与既往的生长轨迹有偏差
	异常的生命体征：静息状态下心率或血压降低；直立时心率增加（>20次/min）或血压下降（<10 mmHg）；体温过低
	情绪平淡或焦虑
	皮肤苍白、干燥；胡萝卜素血症（特别是手掌和脚底）
	恶病质：面部消瘦，皮下脂肪减少，肌肉量减少
	毛发稀疏
	心脏杂音（1/3伴有左房室瓣脱垂），四肢冰凉，手足发绀
	左下腹粪便团块
	青春期发育的延迟：乳房小，阴道干燥；睾丸小
与清除有关的特征	生命体征异常：直立时心率增加（>20次/min）或血压下降（<10 mmHg）
	牙釉质腐蚀、口角炎、上腭部划痕
	Russell's征（自我催吐导致指关节磨损或结茧）
	唾液腺肿大（腮腺和下颌下腺）
	上腹部压痛
	脊柱挫伤或擦伤（与过度运动或仰卧起坐有关）

分类	躯体症状
营养不良：与能量摄入不足有关的特征	在身高、体质量和体质量指数图表上与既往的生长轨迹有偏差
	异常的生命体征：静息状态下心率或血压降低；直立时心率增加（>20次/min）或血压下降（<10 mmHg）；体温过低
	情绪平淡或焦虑
	皮肤苍白、干燥；胡萝卜素血症（特别是手掌和脚底）
	恶病质：面部消瘦，皮下脂肪减少，肌肉量减少
	毛发稀疏
	心脏杂音（1/3伴有左房室瓣脱垂），四肢冰凉，手足发绀
	左下腹粪便团块
	青春期发育的延迟：乳房小，阴道干燥；睾丸小
与清除有关的特征	生命体征异常：直立时心率增加（>20次/min）或血压下降（<10 mmHg）
	牙釉质腐蚀、口角炎、上腭部划痕
	Russell's征（自我催吐导致指关节磨损或结茧）
	唾液腺肿大（腮腺和下颌下腺）
	上腹部压痛
	脊柱挫伤或擦伤（与过度运动或仰卧起坐有关）

编号	条件
1	BMI≤相应年龄和性别青少年BMI中位数的75%
2	脱水
3	电解质紊乱（低钾血症、低钠血症、低磷血症）
4	心电图异常（如QTc延长）
5	生理上的不稳定性：严重心动过缓（日间心率<50次/min；夜间心率<45次/min）低血压（<90/45 mmHg）低体温（<35.6 ℃）体位性脉搏增加（>20次/min）或体位性血压降低（收缩期>20 mmHg或舒张期>10 mmHg）
6	生长发育受阻
7	门诊治疗失败
8	严重拒食
9	无法控制的暴饮暴食和清除行为
10	营养不良导致的急性并发症（晕厥、癫痫发作、心力衰竭、胰腺炎等）
11	因共病其他精神障碍或躯体疾病导致无法门诊治疗（如严重抑郁、自杀意念、强迫性障碍、1型糖尿病）

中国神经性厌食症诊疗专家共识

Chinese Expert Consensus on the Diagnosis and Treatment of Anorexia Nervosa

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心理治疗类型	治疗目标	推荐疗程	推荐强度/证据级别
FT	通过调整家庭的互动模式，使家庭系统具有更好的功能来支持个体康复，从而改善患者症状	1次/周，持续数月	A/1b
FBT	通过赋能予父母负责青少年体质量恢复，逐步调整为适当控制、最终帮助青少年独立发展	6个月，20次访谈	A/1a
CBT-E	聚焦于改变患者对于体质量体形的歪曲认知，纠正或改善异常的进食行为	4~6个月，20~40次访谈	B/2a
DBT	通过一系列技巧训练，帮助患者认识自我，学会调整情绪，建立良好的人际关系以及学会承受生活中不可避免的痛苦	6个月，每周1次个体访谈和1次技能团体	C/4
其他（PDT、 IPT等）	帮助患者理解饮食行为症状背后的潜意识动机、冲突，或人际关系模式等，帮助患者发展更加灵活及具有适应性的应对方式	4~12个月，15~50次访谈不等	D/5

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心理治疗类型	治疗目标	推荐疗程	推荐强度/证据级别
CBT-E	聚焦于改变患者对于体质量体形的歪曲认知，纠正或改善异常的进食行为	4~6个月，20~40次访谈	A/1a
PDT	帮助患者理解饮食行为症状背后的潜意识动机、冲突、防御方式等，帮助患者发展更加灵活及具有适应性的应对方式	约1年，50次访谈	B/2a
DBT	通过一系列技巧的训练，帮助患者认识自我，学会调整情绪，建立良好的人际关系以及学会承受生活中不可避免的痛苦	6个月，1次/周个体访谈和1次技能团体	B/2b
IPT	聚焦于识别和改变导致进食问题发生、发展和持续的人际关系背景	4~5个月，15~20次访谈	B/2b

心理治疗类型	治疗目标	推荐疗程	推荐强度/证据级别
CBT-E	聚焦于改变患者对于体质量体形的歪曲认知，纠正或改善异常的进食行为	4~6个月，20~40次访谈	A/1a
PDT	帮助患者理解饮食行为症状背后的潜意识动机、冲突、防御方式等，帮助患者发展更加灵活及具有适应性的应对方式	约1年，50次访谈	B/2a
DBT	通过一系列技巧的训练，帮助患者认识自我，学会调整情绪，建立良好的人际关系以及学会承受生活中不可避免的痛苦	6个月，1次/周个体访谈和1次技能团体	B/2b
IPT	聚焦于识别和改变导致进食问题发生、发展和持续的人际关系背景	4~5个月，15~20次访谈	B/2b