CPG for Eating Disorders

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– Oral nutritional support in eating disorder inpatients is deemed adequate (favourableprogress) when a ponderal gain greater than 0.5 kg per week is produced, with up to 1 kgincrements being the usual during that period. Sometimes, when the patient withmoderate malnutrition resists resuming normal feeding, the diet can be reduced by 500-700 kcal and be supplemented by complementary oral enteral nutrition in the sameamount, which must be administered after meals and not instead of meals (Goodclinical practice). Recommendation 9.GM.04.– In the case of severe malnutrition, extreme starvation, poor progress or lack ofcooperation of the patient in terms of eating, artificial nutrition treatment is indicated. Ifpossible, an oral diet with or without oral enteral nutrition is always the first step,followed by a 3 to 6 day period to assess the degree of collaboration and medicalnutritionalevolution. (Good clinical practice). Recommendation 9.GM.05.– Regarding estimated energetic requirements, it is recommended that caloric needs at thebeginning always be below the usual, that real weight, as opposed to ideal weight, is usedto make the estimation and that in cases of severe malnutrition energetic requirements be25 to 30 kcal/kg real weight or total kcal not higher than 1,000/day. (Good clinicalpractice). Recommendation 9.GM.06.4) Pharmacological interventions– Pharmacological treatment is not recommended as the only primary treatment of AN.(Grade D). Recommendation 9.GPH.1.– Caution should be exercised when prescribing pharmacological treatment for patientswith AN who have associated comorbidities such as obsessive-compulsive disorder(OCD) or depression. (Grade D). Recommendation 9.GPH.2.– If drugs with adverse cardiovascular effects are administered, ECG monitoring of patientsshould be carried out. All patients with AN must be warned of the side effects ofpharmacological treatments. (Grade D). Recommendations 9.GPH.4 and 9. GPH.5.5) Psychological therapiesThe objective of psychological treatment is to reduce risk, to encourage weight gain by means ofa healthy diet, to reduce other symptoms related with eating disorders and to facilitate physicaland psychological recovery. (Grade D). Recommendation 9.GP.3.The psychological therapies that should be considered for AN are: CBT, SFT, IPT, PDT and BT.(Grade D). Recommendation 9.GP.1.– The duration of psychological treatment should be of at least 6 months when performedon an outpatient basis (with physical monitoring) and 12 months for individuals who havebeen under inpatient management. (Grade D). Recommendation 9.GP.5.– For patients with AN who have undergone outpatient psychological therapy but have notimproved or have deteriorated, the indication of more intensive treatments (combinedindividual and family therapy, day or inpatient care) must be considered. (Grade D).Recommendation 9.GP.6.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS202
– Following hospital discharge, patients with AN should be offered outpatient care thatincludes monitoring of normal weight restoration and psychological intervention thatfocuses on eating behaviour, attitudes to weight and shape and the fear of social responseregarding weight gain, along with regular physical and psychological follow-up. Follow-upduration must be of at least 12 months. (Grade D). Recommendation 9.GP.10.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS203
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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
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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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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 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
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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
Page 224 and 225: 33. APPLICABLE ONLY TO WOMEN. My la
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
Page 234 and 235: Annex 2.8. Spanish version of the E
Page 236 and 237: Formula:Patients with eating disord
Page 238 and 239: Annex 3. Information for patients w
Page 240 and 241: Alert SignsWhat signs can alert us
Page 242 and 243: members can seek support and guidan
Page 244 and 245: therapist who guides the sessions a
Page 246 and 247: negative attitudes towards weight a
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Page 250 and 251: 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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