中国神经性贪食诊疗专家共识

doi:10.12114/j.issn.1007-9572.2023.0443

中国全科医学 ›› 2023, Vol. 26 ›› Issue (36): 4487-4497.DOI: 10.12114/j.issn.1007-9572.2023.0443

中国神经性贪食诊疗专家共识

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, 陈妍¹, 陈涵¹, 刘兰英¹, 孔庆梅², 乔慧芬³, 张岚⁴, 李雪霓², 匡桂芳⁵, 张大荣², 栗克清⁶, 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）
3．210024　江苏省南京市，南京医科大学附属脑科医院
4．610041　四川省成都市，四川大学华西医院心理卫生中心
5．266075　山东省青岛市，青岛大学附属妇女儿童医院
6．071000　河北省保定市，河北省精神卫生中心

收稿日期:2023-07-09 修回日期:2023-07-21 出版日期:2023-12-20 发布日期:2023-08-06
通讯作者: 王振, 陈珏
基金资助:
国家自然科学基金面上项目(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 Bulimia 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 Yan¹, CHEN Han¹, LIU Lanying¹, KONG Qingmei², QIAO Huifen³, ZHANG Lan⁴, LI Xueni², KUANG Guifang⁵, ZHANG Darong², LI Keqing⁶, 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. Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210024, China
4. Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, China
5. Women and Children's Hospital, Qingdao University, Qingdao 266075, China
6. Hebei Mental Health Center, Baoding 071000, China

Received:2023-07-09 Revised:2023-07-21 Published:2023-12-20 Online:2023-08-06
Contact: WANG Zhen, CHEN Jue

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摘要/Abstract

摘要： 神经性贪食是以反复发作的暴食和防止体质量增加的补偿行为，以及对体形和体质量过度关注为特征的一类进食障碍。神经性贪食患者存在紊乱的进食行为，导致电解质异常，出现胃肠道疾病、代谢和内分泌紊乱等躯体问题；其次常共病双相情感障碍、抑郁症、物质使用障碍等多种精神障碍，需引起重视。然而，目前在中国对于神经性贪食，乃至进食障碍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12名专家包括精神科医师和循证医学专家，组成专家组，基于循证医学证据、国内外指南与专家共识、专家经验等制订本专家共识，以期提高国内精神科专业人员和全科医师对神经性贪食的识别和诊治水平。

关键词: 神经性贪食, 心理治疗, 药物治疗, 诊疗指南, 指南

Abstract:

Bulimia nervosa is a type of eating disorders characterized by recurrent binge eating and compensatory behaviors to prevent weight gain, as well as excessive concern about body shape and mass. The patients with bulimia nervosa present with disturbed eating behavior, resulting in electrolyte abnormalities, gastrointestinal disorders, metabolic and endocrine disorders and other physical problems; secondly, the bulimia nervosa patients are often co-morbid with a variety of mental disorders such as bipolar disorder, depression, substance use disorders, which need to be taken seriously. However, bulimia nervosa and even eating disorders cannot be recognized and diagnosed at an early stage in China, which leads to 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, in conjunction with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, this expert consensus was formulated by 12 experts in the field of psychiatry and evidence-based medicine based on evidence-based medicine, domestic and foreign guidelines and expert consensus and expert experience, in order to improve the recognition, diagnosis and treatment of bulimia nervosa by psychiatric professionals and general practitioners in China.

Key words: Bulimia nervosa, Psychological treatment, Drug treatment, Diagnostic and treatment guideline, Guidelines

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,陈妍,等. 中国神经性贪食诊疗专家共识[J]. 中国全科医学, 2023, 26(36): 4487-4497. DOI: 10.12114/j.issn.1007-9572.2023.0443.
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 Yan, et al. Chinese Expert Consensus on the Diagnosis and Treatment of Bulimia Nervosa[J]. Chinese General Practice, 2023, 26(36): 4487-4497. DOI: 10.12114/j.issn.1007-9572.2023.0443.

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推荐强度	证据级别（级）	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（级）	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

项目	治疗目标	适应人群	推荐疗程	推荐强度/证据级别
CBT	打破暴食-清除恶性循环，控制BN症状，降低对自身体质量和体形的过度关注	青少年、成人BN	4~6个月，约20次访谈	A/1a
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	成人BN	4~5个月，15~20次访谈	B/1b
DBT	帮助患者认识自我、学会调节情绪、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，从而减少暴食和清除行为	成人BN	6个月，20次访谈	B/2a
精神动力性心理治疗	帮助患者理解其症状与早年经历、生活事件之间的关系，理解BN症状背后的潜意识冲突、防御方式等，理解暴食和清除行为的心理意义、在其生活中的作用，患者通过领悟从而调整其行为	成人BN	约1年，50次访谈	B/1b
家庭治疗	通过维系家庭平衡，减少暴食清除频率	青少年BN	6个月，20次访谈	A/1a

项目	治疗目标	适应人群	推荐疗程	推荐强度/证据级别
CBT	打破暴食-清除恶性循环，控制BN症状，降低对自身体质量和体形的过度关注	青少年、成人BN	4~6个月，约20次访谈	A/1a
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	成人BN	4~5个月，15~20次访谈	B/1b
DBT	帮助患者认识自我、学会调节情绪、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，从而减少暴食和清除行为	成人BN	6个月，20次访谈	B/2a
精神动力性心理治疗	帮助患者理解其症状与早年经历、生活事件之间的关系，理解BN症状背后的潜意识冲突、防御方式等，理解暴食和清除行为的心理意义、在其生活中的作用，患者通过领悟从而调整其行为	成人BN	约1年，50次访谈	B/1b
家庭治疗	通过维系家庭平衡，减少暴食清除频率	青少年BN	6个月，20次访谈	A/1a

中国神经性贪食诊疗专家共识

Chinese Expert Consensus on the Diagnosis and Treatment of Bulimia Nervosa

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