CPG for Eating Disorders

COMBINED INTERVENTIONSThis section describes the evidence for the efficacy and safety of combined interventions,whether they are psychological or pharmacological, in the treatment of eating disorders.Occasionally, the experimental and control groups receive one or more treatments.9.16. What is the efficacy and safety of combinedinterventions in patients with eating disorders?9.16.1. Anorexia nervosa9.16.1.1. What is the efficacy and safety of combined interventionsin patients with AN?The answer is based on the NICE CPG (2004) 30 , which describes the results from theRCT according to variables of interest. There are no results regarding combined interventionsneither in the quality systematic review of scientific evidence (1++) elaborated by the AHRQ ofthe US (2006) 31 nor in the more recent one conducted by Bulik, et al. (2007) 202 . The updatedsearch has identified two new 2 RCTs.The revised literature does not inform on the adverse effects declared over thecourse of the RCT that studied combined interventions on AN.Scientific evidenceIn patients whose clinical picture is not as severe as to require emergency treatment,there is insufficient evidence on whether to administer an outpatient psychologicaltreatment or to proceed to a complete hospitalisation for administration of suchtreatment (group therapy-FT-NC vs. individual therapy-NSFT-NC) according to 1RCT (N=90; Crisp, 1991) 263 .An RCT (Brambilla, 2007, Italy) 318 comprised of 30 women with AN receivingoutpatient treatment compared CBT-olanzapine (daily doses 2.5 mg during the firstmonth and 5 mg the two following months) N=15 (8 restrictive type AN [AN-R] and7 bulimic-purging type AN [AN-BP]) vs. CBT-placebo, N=15 (10 AN-R and 5 AN-BP). There were no significant differences between the two groups in BMI or in theEDI questionnaire score. However, AN-BP treated with CBT-olanzapine improvedthe BMI score significantly (p=0.01) as compared with other groups. Both groupsshowed significant improvement in The Yale Brown Cornell for Eating DisorderRating Scale (p=0.08) score. Differences were not significant upon stratification of thegroups. Both groups obtained a significant in the measurement of aggressiveness(CBT-olanzapine: p=0.006 vs. CBT-placebo: p=0.05) and depression (CBTolanzapine:p=0.01 vs. CBT-placebo: p=0.01). Upon stratification of the groups, AN-BP treated with CBT-olanzapine obtained better results in aggressiveness (p=0.05)than AN-R. There were no differences between these groups in terms of depression.RCT1++RCT1++160CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS