CPG for Eating Disorders

In an RCT (Lock, 2005) 271 , 20% of participants dropped out of treatment. 24% droppedout of long-term therapy and 18% dropped out of short-term therapy. Treatmentdropout as a result of another psychological treatment was reported as an adverseeffect.RCT1 ++Summary of the Evidence(See summary of the evidence for psychological treatment)CPG 30CPG 30In children and adolescents with AN there is insufficient evidence to determinethat separate or conjoint FT has more or less acceptability. (2 RCTs: N=64;Eisler, 2000 267 ; Robin, 1999 272 ).In children and adolescents with AN there is insufficient evidence to determinethat adding body awareness therapy to FT increases acceptability for patientsmore than FT alone (1 RCT; N=33;Wallin, 2000) 273 .Recommendations(See recommendations 9.GP.1. to 9.GP.11.)9.6.2. Bulimia nervosa9.6.2.1. What is the efficacy of FT (systemic) in patients with BN?There is no evidence to respond to this question in the NICE CPG (2004) 30 or in later SRSE 31, 211 .The updated search has identified two more RCTs.Scientific EvidenceIn a recent RCT (Schmith, 2007; UK)238 FT was compared (N=31 BN, N=10EDNOS) with CBT-GSH (N=30 BN, N=14 EDNOS) in adolescents between the agesof 13 and 20 years, with BN or EDNOS. Treatment was administered over 6 monthswith 12-month follow-up. CBT-GSH was more effective at reducing binge-eating at 6months than FT (p=0.03) even though this difference disappeared at 12 months. Therewere no differences between groups in terms of BMI, diet, eating fast and otherattitudinal eating disorder symptoms. The direct cost of treatment was lower for CBT-GSH and no differences were observed in other types of costs. CBT-GSH is slightlysuperior to FT in reducing binge-eating more quickly, being less costly and presentingbetter acceptability for adolescents with BN and/or EDNOS.In a recent RCT (Le Grange, et al., 2007; USA)274 FT (N=41) was compared to FSP(N=31). Patients receiving FT obtained significantly better results after treatment interms of binge-eating and purging abstinence (p=0.049). At 6-months follow-up bingeeatingand purging abstinence was statistically significant in favour of FT (12 patients,29%) compared to SFT (4 patients, 10%; p=0.005). In the measurement of all otherRCT1 ++RCT1++126CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS