CPG for Eating Disorders

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estimator, establishing the following categories: S1= strong evidence (clinically significant ESand CI with a range of clinical relevance (level of evidence I); S2= limited evidence (not a levelof evidence I or situations where one of the CI extremes is not clinically significant); S3=unlikely that it is clinically significant, if it is not a level of evidence I or if ES is statistically butnot clinically significant, and the CI excludes clinically important values; S4= when the ES isnot statistically significant: if the CI is narrow and excludes a clinically significant ES, thedifference is not considered to be clinically significant; S5= but if the CI is wide, it is consideredinsufficient evidence to determine if there was a clinically significant difference or not. S6= ifthe CI includes clinically important values, it is considered insufficient to determine clinicalsignification.3) Method to formulate recommendationsThe importance of acknowledging that the grade of recommendations does not always reflecttheir clinical significance or relevance is emphasised.Annex 6.4. Description of the AHRQ’S SRSE (April, 2006) 31Title: Management of Eating Disorders.Developed by: RTI-UNC Evidence-Based Practice Centre, Research Triangle Park, NC (centreascribed to the AHRQ). The GDG of this guide was advised by and received feedback from atechnical experts panel (TEP) comprised of 11 people, mainly psychiatrics from differentsettings and one family representative. 23 external reviewers, some from the TEP, alsoparticipated.Commissioned and Published By: Agency for Healthcare Research and Quality (AHRQ),USA. AHRQ Publication Nº 06-E010, April 2006.Target Population: AN, BN and EDNOS.Scope: treatment of eating disorders (efficacy, adverse effects, factors associated with treatmentefficacy, sex-, age-, race-, ethnic group- or cultural group-related differences in treatmentefficacy, factors associated with outcomes and sex-, age-, race-, ethnic group- or cultural grouprelatedoutcome differences).Results of Interest: eating-related behaviours, psychiatric or psychological outcomes andbiomarkers.Potential Users: scientific associations, health care professionals, researchers and planners.Funding: Office of Research on Women’s Health (NIH).Methodological Aspects:1) Search for Evidence262CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
Consulted bibliographic databases: MEDLINE, Cumulative Index to Nursing and AppliedHealth (CINAHL), PSYCHINFO, Educational Resources Information Centre (ERIC), NationalAgricultural Library (AGRICOLA) and Cochrane Collaboration Libraries. The guide includesthe search performed. Study inclusion criteria: published in all languages, between 19080 andSeptember 2005, in humans aged 10 years and older, of both sexes, diagnosed mainly with AN,BN or BED and informing on at least one of the relevant results.2) Selection of the EvidenceA reviewer carried out the application of selection criteria to titles and/or summaries. Excludedsummaries were assessed by another expert reviewer, and reasons for exclusion were classified.3) Quality Assessment and Synthesis of the EvidenceEvidence tables were elaborated; an external reviewer extracted data on treatments and results;another reviewer confirmed that they were exact, complete and consistent; both reconcileddisagreements. Each reviewer assessed the quality of the studies. The analysis was focused onstudies qualified as moderate (1+) or high (1++) quality.4) Quality and Strength of the Evidence according to West, et al. (2002) 4472 forms were developed to assess the quality of the studies about treatment (25 items) and results(17 items) that enabled the classification of quality as low, moderate or high. The body ofevidence was graded for each key question based on three dimensions: study quality, results andconsistency of findings. After consensus of three expert researchers, the following levels ofevidence were defined: I=strong, II=moderate, III=weak and IV=no evidence.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS263
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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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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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Page 216 and 217: 30. I eat diet food.31. I feel food
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Page 220 and 221: 6. Do you feel you have control ove
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Page 236 and 237: Formula:Patients with eating disord
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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 256 and 257: CLINICAL PRACTICE GUIDELINE FOR EAT
Page 258 and 259: General Directorate for Public Heal
Page 260 and 261: 2) We identified 20 documents elabo
Page 264 and 265: CLINICAL PRACTICE GUIDELINE FOR EAT
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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