CPG for Eating Disorders

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D 9.GM.4. Legal requirements must be taken into account and complied with whendeciding whether to feed a patient against his/her will.D 9.GM.5. Health care professionals must be careful with the healthy weightrestoration process in children and adolescents with AN, administeringthe nutrients and energy required by providing an adequate diet in orderto promote normal growth and development.Bulimia nervosaD 9.GM.6. Patients with BN who frequently vomit and abuse laxatives can developabnormalities in electrolyte balance.D 9.GM.7. When electrolyte imbalance is detected, in most cases elimination of thebehaviour that caused it is sufficient to correct the problem. In a smallnumber of cases, oral administration of electrolytes whose plasmaticlevels are insufficient is necessary to restore normal levels, except incases involving gastrointestinal absorption.D 9.GM.8. In the case of laxative misuse, patients with BN must be advised on howto decrease and stop abuse. This process must be carried out gradually.Patients must also be informed that the use of laxatives does not decreasenutrient absorption.D 9.GM.9. Patients who vomit habitually must have regular dental check-ups and beprovided with dental hygiene advice.Psychological Therapies for Eating DisordersCognitive-Behavioural therapy (Question 9.3.)Bulimia nervosaA9.3.2.1.1. CBT-BN is a specifically adapted form of CBT and it is recommended that16 to 20 sessions are performed over 4 or 5 months of treatment.B 9.3.2.1.2Patients with BN who do not respond to or refuse to receive CBTtreatment may be offered alternative psychological treatment.D9.3.2.1.3.Adolescents with BN can be treated with CBT adapted to their age, levelof development, and, if appropriate, the family’s intervention can beincorporated.22CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
Binge-Eating DisorderA 9.3.3.1. A specifically adapted form of CBT can be offered to adults with bingeeatingdisorder (BED).Self-Help (guided or not) (Question 9.4.)Bulimia nervosaB 9.4.1.1.1. A possible first step in BN treatment is initiating a SH programme(guided or not).B 9.4.1.1.2. SH (guided or not) is sufficient only in a small number of patients withBN.Interpersonal Therapy (Question 9.5.)Bulimia nervosaB 9.5.2.1. IPT should be considered an alternative to CBT although patientsshould be informed that it requires 8 to 12 months to achieve resultssimilar to those obtained with CBT.Binge-Eating DisorderB 9.5.3.1. IPT-BED can be offered to patients with persistent BED.Family Therapy (systemic or not) (Question 9.6)Anorexia nervosaB 9.6.1.1.1. FT is indicated in children and adolescents with AN.D 9.6.1.1.2. Family members of children with AN and siblings and family membersof adolescents with AN can be included in treatment, taking part inimproving communication, supporting behavioural treatment and sharingtherapeutic information.D 9.6.1.1.3. Children and adolescents with AN can be offered individualappointments with health care professionals, separate from those inwhich the family is involved.D 9.6.1.1.4. The effects of AN on siblings and other family members justifies theirinvolvement in treatment.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS23
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 and 18: D 6.2. In anorexia nervosa (AN), we
Page 19 and 20: D 8.6. Primary care centres should
Page 21: 9.GM.02. Before initiating artifici
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
Page 57 and 58: (causal factors). Participants in t
Page 59 and 60: is a programme that promotes a heal
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
Page 67 and 68: of the five dimension results in th
Page 69 and 70: 6.5. It is recommended to use quest
Page 71 and 72: 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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