CPG for Eating Disorders

In an RCT (Carter, 2003; Canada) 242 the SH-based CBT manual specifically gearedtowards eating disorders was compared to SH with a self-affirmation manual (nonspecific)and to wait-list in 85 adult women with BN under outpatient treatment. Theindividuals who provided guidance were non-specialised facilitators without clinicaltraining. Both SH therapies significantly reduced binge-eating and purging behaviourswhen compared to waiting (wait-list). SH-based CBT was associated with a greaterreduction of excessive exercise compared to the control group (on wait-list) and nonspecificSH.RCT1+Summary of the EvidenceSRSE 311++SRSE 2571++SRSE 2571++Four RCTs provide evidence of the efficacy of SH in BN. There are nodifferences in efficacy between the different types of SH (Carter, 2003) 242 .There is preliminary evidence that indicates that general practitioners can carryout SH treatment. (Durand and King, 2003) 259 .Due to the fact that SH and GSH treatments for BN, when compared to thecontrol group (patients on wait-list or receiving standard treatment), produce ashort-term reduction of eating disorder severity and other symptoms, theseprocedures seem useful as the first step of treatment. It is yet unclear ifguidance is necessary, how much of it and who should provide it. Patientpreference and availability of resources must be taken into account.No significant differences were found in any of the results when SH, GSH andformal psychological therapy administered by a therapist were compared, eventhough it is probable that these analyses do not have sufficient statistical power.However, it is suggested that SH treatments possibly be considered analternative to treatments administered by a specialised therapist, taking both thepatient’s preference and availability of resources into consideration.RecommendationsB 9.4.1.1.1. A possible first step in BN treatment is encouraging patients to initiate aSH programme (guided or not). (Adapted from recommendation 7.2.7.1.of the NICE CPG).B 9.4.1.1.2. SH (guided or not) is sufficient treatment for a limited number of patientswith BN. (Adapted from recommendation 7.2.7.2. of the NICE CPG).9.4.1.2. What is the safety of SH and GSH in patients with BN?The answer in based on the NICE CPG (2004) 30 and on high-quality SRSE (1++) published in2006 31 and 2007 211 . The updated search has not yielded any new evidence. Studies are brieflydescribed in question 9.4.1.1.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS113