CPG for Eating Disorders

Commissioned and Published by: National Institute for Clinical Excellence (NICE) and TheBritish Psychological Society and The Royal College of Psychiatrists, respectively, January2004.Target population: Eating disorders (AN, BN and BED).Scope: aimed at all patients with AN, BN and related eating disorders, who are aged 8 years andolder. The CPG does not include all mental health or physical pathologies in which an eatingdisorder is a symptom.Potential users: scientific associations, health care professionals, researchers, planners, familymembers and educators.Funding: NICE.Methodological Aspects:1) Search for evidenceSRSE in English published or updated after 1995. The search was completed with RCT andother designs. The quality of the SRSE was determined by parallel independent assessment. Theselection and assessment of quality was tested in a representative group of documents. Theguide includes the general and specific search filters developed by the reviewer group.Electronic searches were carried out in the main bibliographic databases: MEDLINE, EMBASE,CINAHL and PSYCINFO. Also in the Cochrane Database of Systematic Reviews, the NHSR&D Health Technology Assessment database, Evidence-Based Mental Health and ClinicalEvidence (Issue 5). In order to include evidence published after search dates, evidence identifiedby experts was reviewed, including reference lists and recent summaries of selected journals.When no SRSE were found, new searches were performed in compliance with the GDG’sdecision.2) Quality and Strength of the EvidenceIntervention studies were classified in accordance with the accepted hierarchy of evidence: Levelof evidence (I, IIa, IIb, III and IV) and grade of recommendation (A, B and C) depending on thetype and level of respectively associated evidence.The levels of evidence of the NICE guide scale correspond to the following levels of the SIGNscale: I=1++; IIa=1+; IIb=1-; III=2 (-, +, ++) and IV=3, 4. A and B grades of recommendationcoincide in both the NICE scales and the SIGN scale used in this CPG. The C grade of theNICE scale could be extrapolated to the D grade of the SIGN scale.When statistically significant results were obtained after controlling heterogeneity, the GDGassessed whether these findings were clinically significant (for example, if benefit for patientswas probable) taking the RCT population, the nature of the outcome and effect size (ES) intoaccount. On this basis, effect size was considered clinically significant or not. The next stepwas to assess the strength of the evidence, by examining the confidence intervals of the effectCLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS261