CPG for Eating Disorders

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negative attitudes towards weight and shape, irrational beliefs on the benefits of being on a diet,social pressure to manage weight, dieting, amongst others. Non-specific interventions address:risk exposure, psychopathology of parents, lack of parental bond, physical and/or psychologicalabuse by family members, amongst others. Discussions/debates are carried out in classrooms,programmed sessions, etc.Interventions aimed at making the patient stronger to tackle the disease (in this case, eating disorders)Primary prevention interventions. Protection is achieved by providing the patient (host) withdifferent skills (life skills, skills to deal with social pressure, to solve problems, etc.) andperforming activities to develop coping skills. Discussions/debates are carried out in classrooms,programmed sessions, etc.Psychoeducational interventionsPrimary prevention interventions that consist of communicating information on a certain matter(in this case, on eating disorders), which will later be the central topic of debate/discussionbetween group participants.LithiumMood stabilising psychoactive drug. The following therapeutic indications have been approved inSpain: prophylaxis and treatment of manic-depressive psychosis, recurrent unipolar depression,endogenous depression resistant to standard treatment, neutropenia following treatment withcytostatics, medullary aplasia and Felty’s syndrome.LorazepamBenzodiazepine that binds with specific receptors in several locations of the NCS, boosting theeffects of synaptic or presynaptic inhibition mediated by GABA or directly affecting the potentialaction of generation mechanisms. The following therapeutic indications have been approved inSpain: short-term treatment of all states of anxiety or tension, associated or not to functional ororganic disorders, psychic disturbances, psychosomatic diseases, organic diseases, sleep disorders,insomnia, hyperemotivity, neurosis. Benzodiazepines are only indicated in the treatment of anintense disorder that limits the patient’s activity or subjects him/her to significant stress.MianserineAntidepressant that blocks peripheral alpha-adrenoreceptors increasing the exchange ofnoradrenaline in the brain. It has slightly sedative, H1 antihistaminic and scarcely anticolinergicactivity. The following therapeutic indications have been approved in Spain: improvement ofdepressive symptoms in depression cases where pharmacological treatment is indicated. It is oneof the interventions in the control group of the RCTs studied in this CPG.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS246
MoclobemideMAOI antidepressant, mainly of the A subtype; decreases metabolism of noradrenaline, dopamineand serotonin, leading to greater extracellular concentrations of these transmitters. Its approvedtherapeutic indication in Spain is major depression.AdvocacyIn a social context, this technique is based on the influence on a person’s or group’s attitudestowards a specific matter.NaloxoneAntagonist of exogenously administered opioids. The following therapeutic indications have beenapproved in Spain: to totally or partially counteract respiratory depression caused by overdose ofnarcotics and dextropropoxifen or pentazocine, and also respiratory depression in the newborncaused by administration of opioids to the mother during delivery. Diagnosis when there issuspicion of acute narcotic intoxication.NaltrexoneAntagonist of exogenously administered opioids. The following therapeutic indications have beenapproved in Spain: alcoholism, opioid withdrawal, accompanied by other therapeutic measures.OlanzapineAntipsychotic, antimanic and mood stabiliser with an affinity for serotonin, dopamine, cholinergicmuscarinic, alpha-1-adrenergic and histamine receptors. The following therapeutic indicationshave been approved in Spain: schizophrenia, moderate or severe manic episode, relapseprevention of bipolar disorder whose manic episode has responded to olanzapine treatment,intramuscular administration for immediate management of agitation and disordered behavioursin schizophrenia or manic episode, when oral administration is not recommended.OndasentronPotent antiemetic antagonist that is highly selective of 5-HT3 receptors located in peripheralneurones and within the NCS. The following therapeutic indications have been approved in Spain:management of nausea and vomiting caused by chemotherapy and cytotoxic radiation therapy andpost-operative nausea and vomiting.OrlistatPeripherally acting drug designed to treat obesity.PimozideAntipsychotic drug that selectively blocks dopaminergic central receptors and has neurolepticproperties. The following therapeutic indications have been approved in Spain: acute and chronicpsychosis and anxiety disorders.247CLINICAL 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
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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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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
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 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
Page 262 and 263: estimator, establishing the followi
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
Page 286 and 287: 427. Finnish Medical Society Duodec
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CPG for Eating Disorders

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