CPG for Eating Disorders

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General Recommendations for Psychological Therapy (GP) in EatingDisorders (GP) (Questions 9.3.-9.8.)Anorexia nervosaD 9.GP.1. The psychological therapies to be assessed for eating disorders are: CBT,SFT, IPT, PDT and BT.D 9.GP.2. In the case of patients who require special care, the selection of thepsychological treatment model that will be offered is even moreimportant.D 9.GP.3. The objective of psychological treatment is to reduce risk, to encourageweight gain by means of a healthy diet, to reduce other symptoms relatedwith eating disorders and to facilitate physical and psychologicalrecovery.D 9.GP.4. Most psychological treatments for patients with AN can be performed onan outpatient basis (with physical monitoring) by professionalsspecialised in eating disorders.D 9.GP.5. The duration of psychological treatment should be of at least 6 monthswhen performed on an outpatient basis (with physical monitoring) and 12months for inpatients.D 9.GP.6. For patients with AN who have undergone outpatient psychologicaltherapy but have not improved or have deteriorated, the indication ofmore intensive treatments (combined individual and family therapy, dayor inpatient care) must be considered.D 9.GP.7. For inpatients with AN, a treatment programme aimed at suppressingsymptoms and achieving normal weight should be established. Adequatephysical monitoring is important during renutrition.D 9.GP.8. Psychological treatments must be aimed at modifying behaviouralattitudes, attitudes related to weight and body shape and the fear ofgaining weight.D 9.GP.9. The use of excessively rigid behaviour modification programmes is notrecommended for inpatients with AN.D 9.GP.10. Following hospital discharge, patients with AN should be offeredoutpatient care that includes monitoring of normal weight restoration andpsychological intervention that focuses on eating behaviour, attitudes toweight and shape and the fear of social response regarding weight gain,along with regular physical and psychological follow-up. Follow-upduration must be of at least 12 months.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS24
D 9.GP.11. In children and adolescents with AN who require inpatient treatment andurgent weight restoration, age-related educational and social needsshould be taken into account.Binge-Eating DisorderA 9.GP.12. Patients must be informed that all psychological treatments have alimited effect on body weight.B 9.GP.13. A possible first step in the treatment of patients with BED is to encouragethem to follow a SH programme (guided or not).B 9.GP.14. Health care professionals can consider providing BED patients with SHprogrammes (guided or not) that may yield positive results. However,this treatment is only effective in a limited number of patients with BED.D 9.GP.15. If there is a lack of evidence to guide the care of patients with EDNOS orBED, health care professionals are recommended to follow the eatingdisorder treatment that most resembles the eating disorder the patientpresents.D 9.GP.16. When psychological treatments are performed on patients with BED, itmay be necessary in some cases to treat comorbid obesity.D 9.GP.17. Adolescents with BED must be provided with psychological treatmentsadapted to their developmental stage.Pharmacological Treatment of Eating DisordersAntidepressants (Questions 9.9.)Bulimia nervosaB 9.9.2.1.1. Patients should be informed that antidepressant treatment can reduce thefrequency of binge-eating and purging episodes but effects are notimmediate.B 9.9.2.1.2. In the treatment of BN, pharmacological treatments other thanantidepressants are not recommended.D 9.9.2.1.3.D 9.9.2.1.4.The dose of fluoxetine used in patients with BN is greater than the doseused for treating depression (60 mg/day).Amongst SSRI antidepressants, fluoxetine is the first-choice drug fortreatment of BN, in terms of acceptability, tolerability and symptomreduction.25CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
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 and 22: 9.GM.02. Before initiating artifici
Page 23: Binge-Eating DisorderA 9.3.3.1. A s
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
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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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