CPG for Eating Disorders

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7. Diagnosis of Eating Disorders (Questions 7.1.-7.3.) 7.1. It is recommended to follow the WHO’s (ICD-10) and the APA’s (DSM-IV o DSM-IV-TR) diagnostic criteria.D 7.2.1. Health care professionals should acknowledge that many patients witheating disorders are ambivalent regarding treatment due to the demandsand challenges it entails.D 7.2.2. Patients and, when deemed necessary, carers should be provided withinformation and education regarding the nature, course and treatment ofeating disorders.D 7.2.3. Families and carers may be informed of existing eating disorderassociations and support groups. 7.2.4. It is recommended that the diagnosis of eating disorders includeanamnesis, physical and psychopathological examinations andcomplementary explorations. 7.2.5. Diagnostic confirmation and therapeutic implications should be in thehands of psychiatrists and clinical psychologists.8. Interventions at the Different Levels of Care (Questions 8.1.-8.4.)D 8.1. Individuals with eating disorders should be treated in the appropriate carelevel based on clinical criteria: outpatient care, day care (day hospital) andinpatient care (general or psychiatric hospital).D 8.2. Health care professionals without specialist experience in eatingdisorders or who are faced with uncertain situations should seek theadvice of a trained specialist when emergency inpatient care is deemedthe most appropriate option for a patient with an eating disorder.D 8.3. The majority of patients with BN can be treated on an outpatient basis.Inpatient care is indicated when there is risk of suicide, self-inflictedinjuries and serious physical complications.D 8.4. Health care professionals should assess patients with eating disorders andosteoporosis and advise them to refrain from performing physicalactivities that may significantly increase the risk of fracture.D 8.5. The paediatrician and the family physician must be in charge of themanagement of eating disorders in children and adolescents. Growth anddevelopment must be closely monitored.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS18
D 8.6. Primary care centres should offer monitoring and management ofphysical complications to patients with chronic AN and repeatedtherapeutic failures who do not wish to be treated by mental healthservices.D 8.7. Family members, especially siblings, should be included in theindividualized treatment plan (ITP) of children and adolescents witheating disorders. The most common interventions involve sharing ofinformation, advice on behavioural management of eating disorders andimproving communication skills. The patient’s motivation to changeshould be promoted by means of family intervention.D 8.8. Where inpatient care is required, it should be carried out within areasonable distance to the patient’s home to enable the involvement ofrelatives and carers in treatment, to enable the patient to maintain socialand occupational links and to prevent difficulties between care levels.This is particularly important in the treatment of children and adolescentsD 8.9. Patients with AN whose disorder has not improved with outpatienttreatment must be referred to day patient treatment or inpatient treatment.For those who present a high risk of suicide or serious self-inflictedinjuries, inpatient management is indicated.D 8.10. Inpatient treatment should be considered for patients with AN whosedisorder is associated with high or moderate risk due to common disease orphysical complications of AN.D 8.11. Patients with AN who require inpatient treatment should be admitted to acentre that ensures adequate re-nutrition, avoiding the re-feedingsyndrome, with close physical monitoring (especially in the first fewdays), along with the appropriate psychological intervention.D 8.12. The family physician and paediatrician should take charge of theassessment and initial intervention of patients with eating disorders whoattend primary care.D 8.13. When management is shared between primary and specialised care, thereshould be close collaboration between health care professionals, patientsand relatives and carers. 8.14. Patients with confirmed diagnosis or clear suspicion of an eating disorderwill be referred to different health care resources based on clinical andage criteria.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS19
Page 1 and 2: Clinical Practice Guidelinefor Eati
Page 3: This clinical practice guideline (C
Page 6 and 7: Annex 2.7. Diagnostic Criteria for
Page 8 and 9: This CPG aims to provide the popula
Page 11 and 12: External Review of Patient Informat
Page 13 and 14: 14. What is the efficacy and safety
Page 15 and 16: CLINICAL PRACTICE GUIDELINE FOR EAT
Page 17: D 6.2. In anorexia nervosa (AN), we
Page 21 and 22: 9.GM.02. Before initiating artifici
Page 23 and 24: Binge-Eating DisorderA 9.3.3.1. A s
Page 25 and 26: D 9.GP.11. In children and adolesce
Page 27 and 28: Binge-Eating DisorderD 9.GPH.6. In
Page 29 and 30: 11. Prognosis of Eating Disorders (
Page 31 and 32: ED: Eating disorderEDNOS: Eating di
Page 33 and 34: 1. IntroductionBackgroundThe develo
Page 35 and 36: However, there is a need for a guid
Page 37 and 38: Table 2. Studies on the prevalence
Page 39 and 40: 2. Scope and ObjectivesTarget Popul
Page 41 and 42: Aspects not included in the CPGThe
Page 43 and 44: 3. MethodologyThe methodology emplo
Page 45 and 46: - Synthesis and analysis of the sci
Page 47 and 48: 4. Definition and Classification of
Page 49 and 50: - Other psychopathological disturba
Page 51 and 52: Sociocultural factorsThe studies id
Page 53 and 54: accompany eating disorders. However
Page 55 and 56: 5. Prevention of Eating DisordersKe
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Page 61 and 62: MA 1341++MA 1341++No definitive con
Page 63 and 64: Of all the proposed criteria and re
Page 65 and 66: Spanish version of the EAT-40In Spa
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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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CLINICAL PRACTICE GUIDELINE FOR EAT
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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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In yet another RCT (Carter, 1998 26
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Scientific EvidenceThere is insuffi
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Recommendations(See also recommenda
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Summary of the Evidence(See summary
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In an RCT (Lock, 2005) 271 , 20% of
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elaborated by the AHRQ of the US (2
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SUMMARY OF THE EVIDENCE FORPSYCHOLO
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D 9.GP.6. For patients with AN who
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PHARMACOLOGICAL TREATMENTIn this se
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9.9.1.2. What is the safety of anti
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There is strong evidence that antid
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Summary of the EvidenceSRSE 311++SR
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There is insufficient evidence sugg
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An RCT (Appolinario, 2003; Brazil)
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9.10. AntipsychoticsEvidence in AN
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9.11.2. What is the safety of cypro
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9.13.1.2. What is the safety of top
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Recommendations(See recommendations
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SUMMARY OF THE EVIDENCE FORPHARMACO
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COMBINED INTERVENTIONSThis section
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Antidepressants vs. antidepressants
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There is insufficient evidence to s
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Summary of the EvidenceSRSE 311++SR
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9.16.3. Binge-eating disorder9.16.3
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TREATMENT OF EATING DISORDERS THATO
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TREATMENT OF CHRONIC EATING DISORDE
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10. Assessment of Eating DisordersK
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EDI-2 (Version 2 of the EDI-1)Later
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BIABody Image Assessment. Collins,
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10.1.5. The use of questionnaires a
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has been widely used. It consists o
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out as the most adequate, given its
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abuse/dependency, low sensation see
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the freedom of articles 17 of the S
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12.2. Is the informed consent of an
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RecommendationAccording to current
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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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