CPG for Eating Disorders

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out as the most adequate, given its higher reliability, internal consistency and sensitivity tochange 385 .Spanish version of the Y-BOCSThere is a version adapted and validated in our setting by Sal, et al., 2002 386CY-BOCS (children and adolescent version of the Y-BOCS)Spanish version of the CY-BOCSThere is a version that has been adapted and validated in our setting by Ulloa, et al., 2004 387Recommendation 10.2. It is recommended to use questionnaires that have been adapted andvalidated in the Spanish population for the psychopathological assessmentof eating disorders. At present, the following instruments arerecommended to carry out the psychopathological assessment of eatingdisorders (version selection based on age and other applicationconditions):- Impulsiveness: BIS-11- Anxiety: STAI, HARS, CETA- Depression: BDI, HAM-D, CDI- Personality: MCMI-III, MACI, TCI-R, IPDE- Obsessive ness: Y-BOCS.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS184
11. Prognosis of Eating DisordersKey Questions:11.1. What is the prognosis of eating disorders?11.2. Are there prognostic factors for eating disorders?11.1. What is the prognosis of eating disorders?Anorexia nervosaThere are contradictory data on the prognosis of AN despite its long historical trajectory,motivated by several factors: follow-up studies with great temporal variability, different resultsdepending on when these studies are performed, lack of randomised intervention studies withsufficient outcome assessment, etc.Acknowledging the previous limitations, results derived from the review of the mainstudies and SRSE of AN prognosis indicate that: mean gross mortality rate is 5% with a highstandard deviation (5.7) and a 0 to 22 interval 388, 389 . Gross mortality rates are generally superior tothose of the general population and increase significantly with the duration of follow-up. Incontrast to this data, it seems that the overall outcome in survivors improves with duration offollow-up (with the resulting therapeutic implications).50% of AN cases resolve in complete remission 390-392 . Partial remission is observed in 20%-30% of AN cases 388, 391 . Between 10% and 20% of cases result in chronicity 389, 391, 393 .Bulimia nervosaThe natural course of BN at 5 years in patients who live in a community is as follows: eachyear, 33% result in remission and 33% in relapse. This information indicates a relatively poorprognosis for non-treated individuals 74 .In 6-year follow-up studies of treated individuals, 60% were determined to have goodprognosis, 30% were considered partially recovered and 10% were determined to have poorprognosis 394 .Risk factors of diagnosis modification (AN to BN or vice versa)There is a lack of prospective studies focused on the evolution of AN based on the survivalanalysis model. However, the following risk factors for diagnosis modification from AN to BNor from BN to AN are: low self-sufficiency or autonomy, high paternal criticism, alcohol185CLINICAL 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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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
Page 134 and 135: SUMMARY OF THE EVIDENCE FORPSYCHOLO
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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 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 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
Page 210 and 211: 15. Future research recommendations
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
Page 218 and 219: Annex 2.4. Spanish version of the C
Page 220 and 221: 6. Do you feel you have control ove
Page 222 and 223: 20. I feel sad after eating more th
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Page 226 and 227: 12. Do you eat reasonable amounts o
Page 228 and 229: Annex 2.7. Diagnostic Criteria for
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Page 232 and 233: 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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