CPG for Eating Disorders

Scientific EvidenceIn an RCT (McInstosh, 2005) 216 , there was an overall dropout rate of 38% in the grouptreated with IPT. No adverse effects were reported.RCT1+Summary of the Evidence(See summary of the evidence for psychological treatment)Recommendations(See recommendations 9.GP.1. to 9.GP.11.)9.5.2. Bulimia nervosa9.5.2.1. What is the efficacy of IPT in patients with BN?The evidence for this question is based on the NICE CPG (2004) 30 , where RCTs aredescribed in terms of outcome variables, and on the high-quality (1++) SRSE elaborated by theAHRQ of the US (2006) 31 and a more recent high-quality (1++) one published by Shapiro, et al.(2007) 211 . The updated search has not yielded any new evidence.Variable: reduction / remission of binge-eating and purgingThere is strong evidence that suggests that CBT-BN treatment is more effective thanIPT-BN in the remission of binge-eating (2 RCTs; N=270; Agras, 2000 227 ; Fairburn,1986 228 ; RR: 0.77; 95% CI: 0.67 to 0.87; NNT: 5; 95% CI: 4 to 20) and purging by theend of treatment (1 RCT; N=220; Cooper, 1995 225 ; RR: 0.76; 95% CI: 0.67 to 0.86;NNT: 5; 95% CI: 4 to 8).RCT1 ++There is evidence that indicates that there are no significant differences between CBT-BN and IPT-BN in the remission of binge-eating at post-treatment follow-up (2 RCTs;N=270; Agras, 2000 227 ; Fairburn, 1986 228 ; RR: 0.93; 95% CI: 0.82 to 1.06).RCT1 ++It is not likely that CBT-BN is superior to IPT-BN in reducing the frequency of bingeeating(2 RCTs; N=262;Agras, 2000 227 ; Fairburn, 1986 228 ; SMD: -0.24; 95% CI: -0.48 to0.01) and purging (2 RCTs; N=257; Agras, 2000 227 ; Fairburn, 1986 228 ; SMD: -0.04; 95%CI: -0.29 to 0.20) by the end of treatment.RCT1 ++Variables: depression and/or interpersonal and psychosocial functioningand/or general psychiatric symptomsThere is insufficient evidence to determine that there are significant differencesbetween CBT and IPT in general psychiatric symptom scores by the end of treatmentRCT 1++118CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS