CPG for Eating Disorders

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9.11.2. What is the safety of cyproheptadine in patients with AN?The answer is based on the NICE CPG (2004) 30 . The updated search has not yielded any newevidence.Scientific EvidenceThere is insufficient evidence to determine that antidepressants, antihistamines orantipsychotics are more or less acceptable to patients with AN when compared toplacebo or wait-list.There is insufficient evidence to determine that antidepressants, antihistamines orantipsychotics produce more or less adverse effects in patients with AN when comparedwith placebo or wait-list.RCT1++RCT1++Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)9.12. Opioid antagonistsEvidence has been found for the following opioid antagonist in the treatment of BN:naltrexone. No evidence on the use of naloxone (also an opioid antagonist) in BNT/BEDtreatment has been found.9.12.1. Bulimia nervosa9.12.1.1. What is the efficacy of naltrexone in patients with BN?The answer is based on the NICE CPG (2004) 30 . The updated search has not yielded anynew evidence.Scientific EvidenceThere is insufficient evidence to determine that opioid antagonists (naltrexone) aremore or less effective when compared to placebo in women with mean age 25 yearsdiagnosed with BN (2 RCT; N=28; Huseman, 1990 312 ; Mitchell, 1989 313 ).RCT1++Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)152CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
9.12.1.2. What is the safety of opioid antagonists in patients with BN?The answer is based on the NICE CPG (2004) 30 . The updated search has not yielded any newevidence.Scientific EvidenceThere is insufficient evidence to determine that opioid antagonists (naltrexone) are moreor less acceptable to patients when compared to placebo in women with mean age 25years who have been diagnosed with BN (2 RCTs; N=28; Huseman, 1990 312 ; Mitchell,1989 313 ).RCT1++Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)9.13. Topiramate9.13.1. Bulimia nervosa9.13.1.1. What is the efficacy of topiramate in patients with BN?Evidence is based on the high-quality SRSE (1++) elaborated by the AHRQ of the US(2006) 31 and also on a more recently published high-quality SRSE (1++) (Shapiro, et al., 2007) 211 .The updated search has not identified any new evidence.Scientific Evidence2 RCTs (Hoopes, 2003; USA 314 ; Hedges, 2003; USA 315 ) compared topiramate vs. placeboin 68 adult patients (97% women) with BN who were being treated on an outpatientbasis. The proportion of abstinence from binge-eating and purging was 22.6% in thetopiramate group and 6% in the placebo group, a non-significant difference. Thetopiramate group was associated with significant reduction of anxiety but not depression,and with a greater tendency towards weight loss. The control group had a tendencytowards weight gain.RCT1+Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)153CLINICAL 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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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.
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PSYCHOLOGICAL THERAPIESIn this sect
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Summary of the Evidence(See also th
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Page 105 and 106: SRSE 2401++SRSE 2401++CBT treatment
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Page 115 and 116: Variable: reduction / remission of
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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
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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 148 and 149: An RCT (Appolinario, 2003; Brazil)
Page 150 and 151: 9.10. AntipsychoticsEvidence in AN
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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
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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
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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
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Page 198 and 199: Algorithm 2. Intervention if there
Page 200 and 201: 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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