CPG for Eating Disorders

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An RCT (Appolinario, 2003; Brazil) 307 compared sibutramine vs. placebo in outpatientswith BED (88% women; mean age 35.2 to 36.6). Sibutramine is associated withdecreased depressive behaviour and is superior to placebo in reducing the frequency andseverity of binge-eating episodes. In the placebo group weight gain was observed duringand by the end of treatment. In the group treated with the drug, weight loss by the end oftreatment was reported.RCT1++Summary of the EvidenceSRSE 311++SRSE 311++In short-term RCTs with SSRI antidepressants, the group treated with thesedrugs presents better results in the reduction of symptoms related with eatingdisorders, in behaviour, weight and severity of the disease. The clinical impactof these conclusions cannot be judged due to the lack of data on total BEDremission and on follow-up.Low doses of imipramine as a complementary strategy to nutritionalcounselling and psychological therapy are associated with reduced binge-eatingand weight loss that is sustained after drug discontinuation.Recommendations(See also recommendation 9.GPH.6.)B 9.9.3.1.1. SSRI antidepressant treatment can be offered to a patient with BED,regardless of whether he/she follows a guided SH programme or not.(Adopted from recommendation 8.3.5.1. of the NICE guide).B 9.9.3.1.2. Patients must be informed that SSRI antidepressant treatment can reducethe frequency of binge-eating, but the duration of long-term effects isunknown. Antidepressant treatment may be beneficial for a small numberof patients. (Adopted from recommendation 8.3.5.2. of the NICE guide).9.9.3.2. What is the safety of antidepressants in patients with BED?The answer is based on the NICE CPG (2004) 30 , which describes the results of RCTs, onthe high-quality SRSE (1++) elaborated by the AHRQ of the US (2006) 31 and a more recentlypublished one carried out by Brownley, et al. (2007) 245 . The updated search has not identifiedany new evidence. Studies are briefly described in question 9.9.3.1.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS148
Scientific EvidenceThere is insufficient evidence to determine if there is a clinically significant differencebetween antidepressants (fluoxetine, fluvoxamine, sertraline, imipramine andcitalopram) and placebo in treatment discontinuation for any reason (5 RCTs; N=248;Arnold, 2002 301 ; McElroy, 2000 302 , 2003 304 ; Hudson, 1998 305 ; Laederach, 1999 303 ; randomeffects model RR: 1.02; 95% CI: 0.43 to 2.42).RCT1++There is insufficient evidence to determine if there is a clinically significant differencebetween antidepressants (fluoxetine, fluvoxamine, sertraline) vs. placebo in treatmentdiscontinuation due to adverse effects (3 RCTs; N=176; Arnold, 2002 301 ; McElroy,2000 302 ; Hudson, 1998 305 ; RR: 2.48; 95% CI: 0.74 to 8.39).RCT1++There is insufficient evidence to determine if there is a clinically significant differencebetween antidepressants (fluoxetine, fluvoxamine, sertraline and citalopram) andplacebo in treatment discontinuation for any reason (4 RCTs; N=217; Arnold, 2002 301 ;McElroy, 2000 302 , 2003 304 ; Hudson, 1998 305 ; random effects model RR: 1.02; 95% CI:0.39 to 2.68) or as a result of adverse effects by the end of treatment (3 RCTs; N=183;Arnold, 2002 301 ; McElroy, 2003 304 ; Hudson, 1998 305 ; RR: 3.03; 95% CI: 0.84 to 10.86).There is insufficient evidence to determine if there is a clinically significant differencebetween tricyclic antidepressants (imipramine) and placebo in treatment discontinuationdue to adverse effects or any other reason (1 RCT; N=31; Laederach, 1999 303 ; RR: 1.07;95% CI: 0.07 to 15.57).In an RCT (Pearlstein, 2003) 306 that compared fluovoxamine with placebo, 20% ofparticipants dropped out of treatment.In an RCT (Appolinario, 2003) 307 , 23% of participants in the sibutramine group and 17%of participants in the placebo group dropped out of treatment. The adverse effects ofsibutramine were: dry mouth (22 cases); headache (6); constipation (7). In the placebogroup: dry mouth (3); headache (14); constipation (0) (p
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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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accompany eating disorders. However
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5. Prevention of Eating DisordersKe
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(causal factors). Participants in t
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is a programme that promotes a heal
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MA 1341++MA 1341++No definitive con
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Of all the proposed criteria and re
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Spanish version of the EAT-40In Spa
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of the five dimension results in th
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6.5. It is recommended to use quest
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7.2. How are eating disorders class
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to help them cope with the situatio
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Other examinationsTo ascertain whet
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- Initiating nutritional treatment
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8.2. In eating disorders, what clin
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8.3.2. Criteria for admission to da
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RecommendationsD 8.1. Individuals w
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9. Treatment of Eating DisordersThe
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An RCT (Rigaud, 2007; France) 203 c
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9.2. Nutritional Counselling (NC)9.
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Recommendations(See recommendations
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Anorexia nervosaRecommendationsD 9.
Page 97 and 98: PSYCHOLOGICAL THERAPIESIn this sect
Page 99 and 100: Summary of the Evidence(See also th
Page 101 and 102: There is limited evidence to sugges
Page 103 and 104: In an RCT (Wilson, 2002; USA) 234 C
Page 105 and 106: SRSE 2401++SRSE 2401++CBT treatment
Page 107 and 108: In an RCT (Bulik, 1998) 236 the ove
Page 109 and 110: Evidence indicates that it is unlik
Page 111 and 112: A 9.3.3.1. Adult patients with BED
Page 113 and 114: In an RCT (Carter, 2003; Canada) 24
Page 115 and 116: Variable: reduction / remission of
Page 117 and 118: In yet another RCT (Carter, 1998 26
Page 120 and 121: Scientific EvidenceThere is insuffi
Page 122 and 123: Recommendations(See also recommenda
Page 124 and 125: Summary of the Evidence(See summary
Page 126 and 127: In an RCT (Lock, 2005) 271 , 20% of
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
Page 142 and 143: There is strong evidence that antid
Page 144 and 145: Summary of the EvidenceSRSE 311++SR
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Page 150 and 151: 9.10. AntipsychoticsEvidence in AN
Page 152 and 153: 9.11.2. What is the safety of cypro
Page 154 and 155: 9.13.1.2. What is the safety of top
Page 156 and 157: Recommendations(See recommendations
Page 158 and 159: SUMMARY OF THE EVIDENCE FORPHARMACO
Page 160 and 161: COMBINED INTERVENTIONSThis section
Page 162 and 163: Antidepressants vs. antidepressants
Page 164 and 165: There is insufficient evidence to s
Page 166 and 167: Summary of the EvidenceSRSE 311++SR
Page 168 and 169: 9.16.3. Binge-eating disorder9.16.3
Page 170 and 171: TREATMENT OF EATING DISORDERS THATO
Page 172 and 173: TREATMENT OF CHRONIC EATING DISORDE
Page 174 and 175: 10. Assessment of Eating DisordersK
Page 176 and 177: EDI-2 (Version 2 of the EDI-1)Later
Page 178 and 179: BIABody Image Assessment. Collins,
Page 180 and 181: 10.1.5. The use of questionnaires a
Page 182 and 183: has been widely used. It consists o
Page 184 and 185: out as the most adequate, given its
Page 186 and 187: abuse/dependency, low sensation see
Page 188 and 189: the freedom of articles 17 of the S
Page 190 and 191: 12.2. Is the informed consent of an
Page 192 and 193: RecommendationAccording to current
Page 194 and 195: CLINICAL PRACTICE GUIDELINE FOR EAT
Page 196 and 197: CLINICAL PRACTICE GUIDELINE FOR EAT
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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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CPG for Eating Disorders

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