CPG for Eating Disorders

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SUMMARY OF THE EVIDENCE FORPHARMACOLOGICAL TREATMENT(QUESTIONS 9.9. to 9.15.)SRSE 311++Dropout rates in the RCT assessing pharmacological treatments ranged from0% to 51% of treated cases. No drug in particular showed a greater relapse ratethan others.Anorexia nervosaSRSE 311++The literature relating to medication in AN is scarce and inconclusive.Binge-Eating DisorderSRSE 311++There is moderate evidence that supports the role of drugs in the treatment of BED.GENERAL RECOMMENDATIONS FOR THEPHARMACOLOGICAL TREATMENT OF EATINGDISORDERS(QUESTIONS 9.9. to 9.15.)Anorexia nervosaD 9.GPH.1. Pharmacological treatment is not recommended as the only primarytreatment in patients with AN. (Adopted from recommendation 6.3.6.1. ofthe NICE guide).D 9.GPH.2. Caution should be exercised when prescribing pharmacological treatmentfor patients with AN who have associated comorbidities such as obsessivecompulsivedisorder (OCD) or depression. (Adopted fromrecommendation 6.3.6.2. of the NICE guide).D 9.GPH.3. Given the risk of heart complications presented by patients with AN,prescription of drugs whose side effects may affect cardiac function mustbe avoided. (Adopted from recommendation 6.3.6.4. of the NICE guide).CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS158
D 9.GPH.4. If drugs with adverse cardiovascular effects are administered, ECGmonitoring of patients should be carried out. (Adopted fromrecommendation 6.3.6.3. of the NICE guide).D 9.GPH.5. All patients with AN must be warned of the side effects ofpharmacological treatments. (Adopted from recommendation 6.3.6.5. ofthe NICE guide).Binge-Eating DisorderD9.GPH.6In the absence of evidence to guide the management of BED, it isrecommended that the clinician treat the patient based on the eating problemthat most closely resembles the patient’s eating disorder according to BN orAN guides. (Adopted from recommendation 8.2.7.1. of the NICE guide).159CLINICAL 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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There is limited evidence to sugges
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In an RCT (Wilson, 2002; USA) 234 C
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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
Page 146 and 147: There is insufficient evidence sugg
Page 148 and 149: An RCT (Appolinario, 2003; Brazil)
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 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
Page 198 and 199: Algorithm 2. Intervention if there
Page 200 and 201: 9) Day care admission criteria:- Fr
Page 202 and 203: - Oral nutritional support in eatin
Page 204 and 205: Algorithm 4. Treatment of BN and BE
Page 206 and 207: 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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