CPG for Eating Disorders

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9.16.3. Binge-eating disorder9.16.3.1. What is the efficacy of combined interventions in patients withBED?The answer is based on NICE CPG (2004) 30 , which describes the results yielded by RCTs,and on the high-quality SRSEs (1++), one elaborated by the AHRQ of the US (2006) 31 and themore recently published one conducted by Brownley, et al. (2007) 245 . The updated search hasidentified one new RCT.Scientific EvidenceAn RCT (Grilo, 2005; USA) 329 compared fluoxetine (60 mg/day) vs. placebo vs. CBT vs.CBT-fluoxetine in 108 adult patients (78% women) diagnosed with BED and treated onan outpatient basis for 16 weeks. The groups that received CBT (alone or in combinationwith fluoxetine) achieved better results than the placebo and the fluoxetine alone groupsto reduce the frequency of binge-eating episodes, ED-related symptoms, depression, andgreater frequency of remission. There were no differences with regard to weight.An RCT (Agras, 1994; USA) 325 compared CBT (3 months) – weight loss therapy (6months) –weight loss therapy (9 months) vs. CBT (3 months) – weight loss therapy (6months) - desipramine (300 mg/day) in 109 adult women with BED on an outpatientbasis. The groups that received CBT experienced a significant in the binge-eatingepisodes after 12 weeks of treatment, even though the effect was not maintained at the 1year follow up. There were no differences regarding depression scores among thegroups. At treatment initiation, the weight loss was greater in the group receiving weightloss therapy. At the 3-month follow up, the weight loss was greater in the CBTdesipraminegroup (mean weight loss: 4.8 Kg).An RCT (Grilo, 2005; USA) 330 compared CBT-orlistat (120 mg 3/day) vs. CBT-placeboover12 weeks of treatment in 50 adult patients (88% women) (BMI>30) with BEDundergoing outpatient treatment. The group on orlistat had a greater remission rate attreatment completion, but not so at the 2-month follow up. This group also experiencedweight loss.An RCT (Devlin, 2007; USA) 331 comprised of 116 people suffering from BED (90females and 26 males) (age range: 18-70 years) compared individual CBT- fluoxetinevs. individual CBT over 5 months with a follow up at +2 years. Both groups showed animprovement in the frequency of the binge-eating episodes and their remission after 2months of treatment. The odds ratio (odds at 24months/ post-treatment) for remission ofthe binge-eating episodes at 2 years after treatment was 1.373 times the odds atcompletion of 5 months of treatment. Subjects who received individual CBTexperienced a greater reduction in the frequency of binge-eating episodes and greaterremission odds ratio of such episodes as compared to the subjects who had not receivedthis therapy at 2 years. There were no differences regarding weight in neither of thegroups. The group that received fluoxetine achieved better results in the reduction ofdepressive symptoms at 2 years. A short-term treatment may show benefits in the longterm and not all treatments are equivalent in terms of the benefits they provide.RCT1++RCT1+RCT1++RCT1++168CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
Summary of the EvidenceRSEC 31 The combination of pharmacological treatment with CBT can reduce the1++ occurrence of binge-eating episodes and improve weight loss. However, nodefinition has yet been provided as to what the best medication is to maintain theweight loss. Moreover, there are no empiric data on what the ideal treatmentduration might be to maintain BED remission and weight loss.9.16.3.2. What is the safety of combined interventions in patients withBED?The answer is based on NICE CPG (2004) 30 , on the quality SRSE (1++) elaborated by theAHRQ of the US (2006) 31 and on other more recently published publication conducted byBrownley, et al. (2007) 245 . Question 9.16.3.1. describes the studies briefly.Scientific EvidenceIn an RCT (Grilo, 2005; USA) 329 that compared fluoxetine vs. placebo vs. CBT-placebovs. CBT-fluoxetine, the percentage of withdrawals was as follows: placebo (15%),fluoxetine (22%), CBT-placebo (21%), CBT-fluoxetine (23%). No information wasprovided on adverse effects.In an RCT (Agras, 1994) 325 , the withdrawal rate from weight loss therapy was 27%, fromCBT-weight loss therapy it was 17%, and from CBT- weight loss therapy-desipramine itwas 23%. Eight subjects stopped taking desipramine due to adverse effects.An RCT (Grilo, 2005) 330 compared CBT-orlistat (120 mg 3/day) vs. CBT-placebo for 12weeks of treatment in 50 adult patients (88% women) (BMI>30) with BED receivingtreatment on an outpatient treatment basis. The number of withdrawals was as follows:orlistat-CBT (24%); placebo-CBT (20%). The group treated with orlistat-CBT had moregastrointestinal adverse effects.RCT1++RCT1+RCT1++169CLINICAL 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
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In an RCT (Bulik, 1998) 236 the ove
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Evidence indicates that it is unlik
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A 9.3.3.1. Adult patients with BED
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In an RCT (Carter, 2003; Canada) 24
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Variable: reduction / remission of
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Page 120 and 121: Scientific EvidenceThere is insuffi
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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
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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
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 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
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
Page 208 and 209: IntegralcareOutcomeSatisfaction ind
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Page 212 and 213: Annex 1. Levels of Evidence and Gra
Page 214 and 215: Annex 2. Clinical chaptersAnnex 2.1
Page 216 and 217: 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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