CPG for Eating Disorders

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Formula:Patients with eating disorders adequately referred withemergency diagnosis / patients with eating disorders referredwith emergency diagnosis x 100.Standard:To be determined.Proportion of patients who receive diagnostic confirmation within two months ofthe first consultationAppropriate timeinterval:Except in high risk situations, all patients with eatingdisorder shall have the diagnosis and individual therapeuticplan established within two months of the first consultation.Formula:Patients who have been diagnosed in the appropriate timeframe /patients diagnosed with an eating disorder x 100.Standard:To be determined.Percentage of general hospital readmissions at 3, 6, 9 and 12 monthsFormula:Number of patients who are discharged from a generalhospital due to eating disorders, at 3 months-total number ofdischarges in that time frame / total number of discharges toa general hospital in that same time frame due to mentaldisorder x 100.Definitions:Levels of disaggregation:Sources of information:Periodicity:Clarifications:All discharges classified in the ICD-10 will be included(codes F50.0, F50.1, F50.2, F50.3; F50.8 and F50.9 of the10th version).Per autonomous community.Registry of hospital discharges (MBDS)-MSC (Ministry ofHealth and Consumer Affairs).3, 6, 9, 12 months (to be determined).Discharges from general hospitals will be counted. Thenumerator is currently biased by not being able to identifypatients who have been discharged from different hospitalsuntil all databases of the individual health care card ofautonomous communities of the NHS are integrated.236CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
Proportion of patients seen with the diagnosis of eating disorder in PC, adultand children’s MHC (MHCFA –MHCFCA), day hospital and general hospitalFormula:Definitions:Levels of disaggregation:Sources of information:Number of patients diagnosed with an eating disorder/totalpopulation x 100.Prior agreement of the autonomous communities on registerand coding criteria of cases managed on an outpatient levelby mental health specialised services is required. Alladmissions classified in the ICD-10 will be included (codesF50.0, F50.1, F50.2, F50.3; F50.8 and F50.9 of the 10 thversion).According to type of eating disorder, level of care (PC,MHC, day hospital and general hospital), autonomouscommunity, age and sex.Death statistics and population projections. NSI.Periodicity:Observations:Annual.At present there are no data for the entire NHS. It requiresthe previous agreement of normalised registry criteria andsubsequent sharing of information by the MSC.Satisfaction index of patients and family members by the end of treatmentFormula:Definition:Levels of disaggregation:Periodicity:Clarifications:Number of surveyed individuals who deemed all aspectsto be adequate / total number of surveyed individuals x100.All patients treated in primary and specialised care foreating disorders will be included at the end of treatment.According to type of eating disorder, autonomous communityand age and sex groups.Annual.Only those individuals who refuse to complete thequestionnaire will be excluded. Returned questionnaires andthe characteristics of those who answered and those who didnot will have to be reported. Expected response rate is 50%.237CLINICAL 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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has been widely used. It consists o
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out as the most adequate, given its
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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 198 and 199: Algorithm 2. Intervention if there
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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
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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 232 and 233: Bulimia nervosa (307.51)Diagnostic
Page 234 and 235: Annex 2.8. Spanish version of the E
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
Page 282 and 283: 341. Hodes M, Timimi S, Robinson P.
Page 284 and 285: 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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