CPG for Eating Disorders

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no differences between groups in terms of BMI, diet, eating fast and other behaviouralattitudes related to eating behaviour. The direct cost of treatment was lower for CBT-GSH and no differences were observed in other types of costs.In a recent RCT (Burton, 2007; U.S.) 239 45 women (age range: 14-23 years) fromdifferent educational institutions were recruited. They belonged to different ethnicgroups and social classes and presented depressive symptoms. The group treated withdepression-aimed CBT was compared to a control group (on wait-list). CBT wasadministered for 4 weeks (weekly one-hour sessions) with follow-up at 1 and 6 months.A significant reduction of depressive symptoms was observed in the group treated withCBT, compared to the control (p
SRSE 2401++SRSE 2401++CBT treatment in patients with BN at 6 and 12 months follow-up produced a90% decrease in binge-eating and purging and, at one-year follow-up, 36% ofpatients remitted in terms of binge-eating and purging.Individual and group CBT treatment reduces the main symptoms of BN (bingeeatingand purging) and related short and long-term psychological effects.CPG 30CBT-GSH is superior to FT by reducing binge-eating more rapidly, being lessexpensive and more acceptable for adolescents with BN and/or EDNOS.Further research is necessary to determine if different groups of adolescentsrespond differently to FT and CBT-GSH and which different ways of involvingthe family in treatment can be more or less beneficial (Schmidt, 2007) 238 .RecommendationsA 9.3.2.1.1. CBT-BN is a specifically adapted form of CBT and it is recommended that16 to 20 sessions be performed over 4 or 5 months of treatment. (Adoptedfrom recommendation 7.2.7.3. of the NICE CPG). intervention can beincorporated. (Adopted from recommendation 7.2.7.4. of the NICE CPG).B 9.3.2.1.2.D 9.3.2.1.3.Patients with BN who do not respond to or refuse to receive CBTtreatment may be offered alternative psychological recommendation(Adopted from recommendation 7.2.7.5. of the NICE CPG).Adolescents with BN can be treated with CBT adapted to the their ageneeds, level of development, and, if appropriate, the family’s treatment.(Adopted from recommendation 7.2.7.4. of the NICE CPG).9.3.2.2. What is the safety of CBT in patients with BN?The answer is based on available evidence for CBT efficacy, where studies are briefly described(question 9.3.2.1.).Scientific EvidenceThere is evidence that indicates that CBT treatment dropout is not likely (9RCTs; N=384;Agras, 1989 222 ; Freeman, 1988 220 ; Griffits, 1994 217 ; Lee, 1986 218 ;Leitenberg, 1988 223 ; Wolf, 1992 221 ; Treasure, 1994 231 ; Mitchell, 1990 243 ; Sundgot-Borgen, 2002 212 ; RR: 1.14; 95% CI: 0.74 to 1.74).There is insufficient evidence that there are significant differences between CBT-BNand BT in the number of dropouts by the end of treatment (3 RCT; N=142; Fairburn,1991 224 ; Freeman, 1988 220 ; Wolf, 1992 221 ; RR: 1.20; 95% CI: 0.61 to 2.37).RCT1 ++RCT1 ++105CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
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Clinical Practice Guidelinefor Eati
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This clinical practice guideline (C
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Annex 2.7. Diagnostic Criteria for
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This CPG aims to provide the popula
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External Review of Patient Informat
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14. What is the efficacy and safety
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CLINICAL PRACTICE GUIDELINE FOR EAT
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D 6.2. In anorexia nervosa (AN), we
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D 8.6. Primary care centres should
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9.GM.02. Before initiating artifici
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Binge-Eating DisorderA 9.3.3.1. A s
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D 9.GP.11. In children and adolesce
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Binge-Eating DisorderD 9.GPH.6. In
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11. Prognosis of Eating Disorders (
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ED: Eating disorderEDNOS: Eating di
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1. IntroductionBackgroundThe develo
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However, there is a need for a guid
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Table 2. Studies on the prevalence
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2. Scope and ObjectivesTarget Popul
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Aspects not included in the CPGThe
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3. MethodologyThe methodology emplo
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- Synthesis and analysis of the sci
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4. Definition and Classification of
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- Other psychopathological disturba
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Sociocultural factorsThe studies id
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Page 71 and 72: 7.2. How are eating disorders class
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Page 83 and 84: 8.3.2. Criteria for admission to da
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Page 89 and 90: An RCT (Rigaud, 2007; France) 203 c
Page 91 and 92: 9.2. Nutritional Counselling (NC)9.
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Page 95 and 96: Anorexia nervosaRecommendationsD 9.
Page 97 and 98: PSYCHOLOGICAL THERAPIESIn this sect
Page 99 and 100: Summary of the Evidence(See also th
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Page 115 and 116: Variable: reduction / remission of
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Page 124 and 125: Summary of the Evidence(See summary
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Page 132 and 133: elaborated by the AHRQ of the US (2
Page 134 and 135: SUMMARY OF THE EVIDENCE FORPSYCHOLO
Page 136 and 137: D 9.GP.6. For patients with AN who
Page 138 and 139: PHARMACOLOGICAL TREATMENTIn this se
Page 140 and 141: 9.9.1.2. What is the safety of anti
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Page 144 and 145: Summary of the EvidenceSRSE 311++SR
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Page 150 and 151: 9.10. AntipsychoticsEvidence in AN
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9.13.1.2. What is the safety of top
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Recommendations(See recommendations
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SUMMARY OF THE EVIDENCE FORPHARMACO
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COMBINED INTERVENTIONSThis section
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Antidepressants vs. antidepressants
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There is insufficient evidence to s
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Summary of the EvidenceSRSE 311++SR
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9.16.3. Binge-eating disorder9.16.3
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TREATMENT OF EATING DISORDERS THATO
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TREATMENT OF CHRONIC EATING DISORDE
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10. Assessment of Eating DisordersK
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EDI-2 (Version 2 of the EDI-1)Later
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BIABody Image Assessment. Collins,
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10.1.5. The use of questionnaires a
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has been widely used. It consists o
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out as the most adequate, given its
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abuse/dependency, low sensation see
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the freedom of articles 17 of the S
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12.2. Is the informed consent of an
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RecommendationAccording to current
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Algorithm 2. Intervention if there
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9) Day care admission criteria:- Fr
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- Oral nutritional support in eatin
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Algorithm 4. Treatment of BN and BE
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14.Dissemination and implementation
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IntegralcareOutcomeSatisfaction ind
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15. Future research recommendations
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Annex 1. Levels of Evidence and Gra
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Annex 2. Clinical chaptersAnnex 2.1
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30. I eat diet food.31. I feel food
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Annex 2.4. Spanish version of the C
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6. Do you feel you have control ove
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20. I feel sad after eating more th
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33. APPLICABLE ONLY TO WOMEN. My la
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12. Do you eat reasonable amounts o
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Annex 2.7. Diagnostic Criteria for
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Within each guideline some variatio
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Bulimia nervosa (307.51)Diagnostic
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Annex 2.8. Spanish version of the E
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Formula:Patients with eating disord
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Annex 3. Information for patients w
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Alert SignsWhat signs can alert us
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members can seek support and guidan
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therapist who guides the sessions a
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negative attitudes towards weight a
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PizotifenThis drug belongs to the g
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TopiramateAnticonvulsant psychoacti
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BULIT Bulimia TestBULIT-R Revised v
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ISCIII Carlos III Health InstituteI
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General Directorate for Public Heal
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2) We identified 20 documents elabo
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estimator, establishing the followi
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17. Detecció i orientacions terap
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59. Lo importante es tu vida. No la
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98. Garner DM. Pathogenesis of anor
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141. Wilksch SM, Tiggemann M, Wade
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181. Rivas T, Jiménez M, Bersabé
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224. Fairburn CG, Jones R, Peveler
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262. McCann UD, Agras WS. Successfu
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302. McElroy SL, Casuto LS, Nelson
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341. Hodes M, Timimi S, Robinson P.
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388. Steinhausen HC. The outcome of
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427. Finnish Medical Society Duodec
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