CPG for Eating Disorders

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Bulimia nervosa (307.51)Diagnostic Criteria:a) Recurrent episodes of binge eating. An episode of binge eating is characterized by:1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of foodthat is definitely larger than most people would eat during a similar period of time andunder similar circumstances.2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannotstop eating or control what or how much one is eating).b) Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such asself-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting;or excessive exercise.c) The binge eating and inappropriate compensatory behaviours both occur, on average, atleast twice a week for 3 months.d) Self-evaluation is unduly influenced by body shape and weight.e) The disturbance does not occur exclusively during episodes of AN.Specify type:– Purging Type: during the current episode of BN, the person has regularly engaged in selfinducedvomiting or the misuse of laxatives, diuretics, or enemas.– Non-purging Type: during the current episode of BN, the person has used otherinappropriate compensatory behaviours, such as fasting or excessive exercise, but has notregularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, orenemasEDNOS (307.50)The EDNOS category refers to eating disorders that do not satisfy criteria for any specific eatingdisorders. For example:• In women, all diagnostic criteria for AN are met, but menstruation is regular (EDNOS 1).• All diagnostic criteria for AN are met but despite substantial weight loss, the patient’sweight is in the normal range (EDNOS 2).• All diagnostic criteria for BN are met except binges and inappropriate compensatorybehaviours occur at a frequency of less than twice a week or for a duration of less than 3months. (EDNOS 3).• All diagnostic criteria for BN are met, except an individual of normal body weight engagesin the regular use of inappropriate compensatory behaviours after eating small amounts of232CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
food (for example, self-induced vomiting after eating two cookies) (EDNOS 4).• Chew and spit out, but not swallow, large amounts of food.• Compulsive disorder: characterised by repeated episodes of binge eating in the absence ofinappropriate compensatory behaviours typical of BN.Though the DSM-IV includes research criteria for later studies, BED remains classified in eatingdisorders not otherwise specified.Table 1. Comparison of diagnostic criteria: DSM-IV, ICD-9, ICD-10DiagnosisDiagnostic ClassificationsDSM-IV-TR ICD-9 ICD-10Anorexia nervosa 307.1 307.1 F50.0Bulimia nervosa 307.51 307.51 F50.2Unspecified eating disorders 307.50 307.50 F50.9233CLINICAL 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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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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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
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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
Page 224 and 225: 33. APPLICABLE ONLY TO WOMEN. My la
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Page 228 and 229: Annex 2.7. Diagnostic Criteria for
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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
Page 248 and 249: PizotifenThis drug belongs to the g
Page 250 and 251: TopiramateAnticonvulsant psychoacti
Page 252 and 253: BULIT Bulimia TestBULIT-R Revised v
Page 254 and 255: ISCIII Carlos III Health InstituteI
Page 258 and 259: General Directorate for Public Heal
Page 260 and 261: 2) We identified 20 documents elabo
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Page 266 and 267: 17. Detecció i orientacions terap
Page 268 and 269: 59. Lo importante es tu vida. No la
Page 270 and 271: 98. Garner DM. Pathogenesis of anor
Page 272 and 273: 141. Wilksch SM, Tiggemann M, Wade
Page 274 and 275: 181. Rivas T, Jiménez M, Bersabé
Page 276 and 277: 224. Fairburn CG, Jones R, Peveler
Page 278 and 279: 262. McCann UD, Agras WS. Successfu
Page 280 and 281: 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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