Neophodnost multidisciplinarnog pristupa u tretmanu poremaćaja ishrane
Sažetak
Poremećaji ishrane predstavljaju složene psihosomatske bolesti koje zahtevaju sveobuhvatan i strogo individualizovan pristup u tretmanu. Cilj rada je prikazati specifičnosti lečenja anoreksije nervoze, bulimije nervoze i poremećaja prejedanja, sa akcentom na nutritivni, farmakološki i psihosocijalni pristup i sa fokusom na porodicu i socijalnu podršku. U radu su razmatrani principi tretmana, uključujući poštovanje individualnih karakteristika pacijenata, uticaj porodičnog i socijalnog okruženja, kao i značaj rane intervencije. Metode lečenja obuhvataju psihoterapiju (individualnu, bihejvioralnu i porodičnu), prilagođeni nutritivni plan, praćenje telesne težine i zdravstvenog stanja, kao i multidisciplinarnu koordinaciju između stručnjaka. Rezultati pokazuju da kombinovani pristup, koji integriše psihološku podršku i nutricionističku intervenciju, doprinosi postepenom oporavku telesne mase, smanjenju anksioznosti i reintegraciji pacijenata u svakodnevni život. Posebna pažnja se posvećuje upravljanju stresom, prevenciji relapsa i adaptaciji na nove životne rutine. Zaključuje se da je holistički, taktičan i human pristup ključan za uspešno lečenje, uz stalnu podršku porodice i multidisciplinarnog tima, uzimajući u obzir kako fizičke, tako i psihičke aspekte bolesti.
Reference
National Institute for Health and Care Excellence (NICE). Eating disorders: recognition and treatment. London: National Institute for Health and Care Excellence; 2017.
Jurčić Z. Razvojna dimenzija anoreksije i bulimije nervoze. Medix. 2004; 52:40–5.
Royal College of Psychiatrists. Guidelines for the nutritional management of anorexia nervosa. London: Royal College of Psychiatrists; 2005.
Sambol K, Cikač T. Anoreksija i bulimija nervoza – rano otkrivanje i liječenje u obiteljskoj medicini. Medicus. 2015; 24(2):165–9.
Barbarich N. et al. Use of nutritional supplements to increase the efficacy of fluoxetine in the treatment of anorexia nervosa. Wiley Inter Science 2003;
Rowel D. et al. Eating Disorders:Best Practice Guidelines for Dietitians 2008;Health service executive
Hay P. Current approach to eating disorders: a clinical update. Advances in Psychiatric Treatment. 2020; 26(6):347–55.
Haller E. Eating disorders ‒ A review and update. West J Med 1992;157: 658‒62.
Fairburn CG. Cognitive Behavior Therapy and Eating Disorders. New York (NY): Guilford Press; 2008.
Murphy R, Straebler S, Cooper Z, Fairburn CG. Cognitive behavioral therapy for eating disorders. Psychiatr Clin North Am. 2010; 33(3):611–27.
Agras WS, Walsh BT, Fairburn CG, Wilson GT, Kraemer HC. A multicenter comparison of cognitive‑behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry. 2000; 57(5):459–66.
Dare C, Eisler I, Russell G, Treasure J, Dodge L. Psychological therapies for adults with anorexia nervosa: randomized controlled trial of out‑patient treatments. Br J Psychiatry. 2001; 178(3):216–21.
Loeb KL, Le Grange D, Lock J. Family‑based treatment of eating disorders in adolescents: current insights and evidence. Int J Child Adolesc Health. 2009; 2(2):243–54.
Couturier J, Kimber M, Szatmari P. Efficacy of family‑based treatment for adolescents with eating disorders: a systematic review and meta‑analysis. Int J Eat Disord. 2013; 46(1):3–11.
Safer DL, Robinson AH, Jo B. Outcome from a randomized controlled trial of group therapy for binge eating disorder: comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behav Ther.2010; 41(1):106–20.
Telch CF, Agras WS, Linehan MM. Dialectical behavior therapy for binge eating disorder: A randomized clinical trial. J Consult Clin Psychol. 2001; 69(6):1061–5.
Fairburn CG, Jones R, Peveler RC, Hope RA, O’Connor M. Psychotherapy and bulimia nervosa: longer‑term effects of interpersonal psychotherapy, behaviour therapy and cognitive behaviour therapy. Arch Gen Psychiatry.1993; 50(6):419–28.
Wilfley DE, Welch RR, Stein RI, Spurrell EB, Cohen LR, Saelens BE, Dounchis JZ, Frank MA, Wiseman CV. A randomized comparison of group cognitive‑behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge‑eating disorder. Arch Gen Psychiatry. 2002; 59(8):713–21.
Yalom ID, Leszcz M. The theory and practice of group psychotherapy. 5th ed. New York (NY): Basic Books; 2005.
Peterson CB, Crosby RD, Wonderlich SA, Mitchell JE, Crow SJ, Engel S. Predicting group cognitive‑behavioral therapy outcome of binge eating disorder using empirical classification. Behaviour Research and Therapy. 2013; 1(9):541–7.
Hay P. A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. Int J Eat Disord. 2013; 46(5):462–9.
Walsh BT, Steinglass JE, et al. Pre‑meal anxiety and food intake in anorexia nervosa. Int J Eat Disord. 2019; 52(3):261–9.
Siopa C, Chaves I, Marques JP, Varino F, Froes P, Pestana PC, Novais F. The Role of New Treatments in Managing Eating Behavior Disorders: A Systematic Review. Curr Treat Options Psychiatry. 2025; 12(1):18.
Fluoxetine Bulimia Nervosa Collaborative Study Group. Fluoxetine in the treatment of bulimia nervosa: a multicenter, placebo‑controlled, double‑blind trial. Arch Gen Psychiatry. 1992; 49(2):139–47.
Muratore AF, Attia E. Psychopharmacologic management of eating disorders: a systematic review. Harv Rev Psychiatry. 2022; 30(3):159–73.
Reas DL, Grilo CM, Mitchell JE, et al. Pharmacotherapy of binge‑eating disorder: a review. Psychiatr Clin North Am. 2015; 38(3):519–34.
Rodan SC, Bryant E, Le A, Maloney D, Touyz S, McGregor IS, Maguire S, et al. Pharmacotherapy, alternative and adjunctive therapies for eating disorders: findings from a rapid review. J Eat Disord. 2023; 11:112.
Hudson JI, McElroy SL, Ferreira‑Cornwell M, Radewonuk J, Gasior M. Efficacy of lisdexamfetamine in adults with moderate to severe binge‑eating disorder: a randomized clinical trial. JAMA Psychiatry. 2016;73(8):841–9.
Crow SJ. Pharmacologic treatment of eating disorders. Curr Psychiatry Rep. 2019;21(10):100.
Sansone RA, Sansone LA. Psychopharmacologic treatment of eating disorders: emerging findings. Innov Clin Neurosci. 2015; 12(5–6):14–9.
Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, Kohn MR, et al. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health. 2012; 50(1):24–9.
Dare C, Eisler I, Hodes M, Russell G, Dodge E, Le Grange D. Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. J Child Psychol Psychiatry. 2001; 42(5):727–36.
Treasure J, Zipfel S, Micali N, et al. Anorexia nervosa. Lancet. 2015; 385(9976):899–911.
Rodgers RF, Paxton SJ, McLean SA. Longitudinal relationships among internalization of the media ideal, peer social comparison, and body dissatisfaction: Implications for the tripartite influence model. Dev Psychol. 2015; 51(5):706–13.
Leonidas C, dos Santos MA. Social support networks and eating disorders: an integrative review of the literature. Neuropsychiatr Dis Treat. 2014; 10:915–27.
Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010; 375(9714):583–93.
Levine LR. Fluoxetine in the treatment of bulimia nervosa. N Engl J Med. 1992; 327:1835–42.
Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci. 2009; 10:573–84.
Bissada H, Mishra A, Ochner CN, et al. Olanzapine in the treatment of anorexia nervosa: a randomized controlled trial. Am J Psychiatry. 2008; 165(10):1281–8.
Hay P, Bacaltchuk J, Stefano S, Kashyap P. Pharmacotherapy for bulimia nervosa and binge eating disorder: systematic review and meta-analysis. Int J Eat Disord. 2009; 42(2):127–39.
Walsh BT. Pharmacotherapy of eating disorders. Int J Eat Disord. 2011; 44(6):456–62.
