CPG for Eating Disorders

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Several studies on the incidence of eating disorders that have been published in NorthAmerica and Europe present a 5- to 6-fold increase in incidence between 1960 and 1970. In1998, a review presented by Pawluck, et al. on the general population of the United Statesreported that annual incidence of AN was 19 per 100,000 in women and 2 per 100,000 inmales 30 . In the review presented by Hoek in 2003, incidence was 8 cases per 100,000 inhabitantsfor AN and 12 cases per 100,000 inhabitants for BN 32 .In a recent study in the United Kingdom (UK), incidence for AN in 2000 was 4.7 per100,000 inhabitants (95% CI: 3.6 to 5.8) and 4.2 per 100,000 inhabitants in 1993 (95% CI: 3.4 to5.0). In Holland, incidence of AN was 7.7 (95% CI: 5.9 to 10.0) per 100,000 inhabitants/yearbetween 1995-1999 and 7.4 between 1985 and 1989 33 . In Navarra, a population survey in 1,07613-year old girls was used to estimate an eating disorder incidence of 4.8% (95% CI: 2.84 to6.82) in a period of 18 months, corresponding to: 0.3% AN (95% CI: 0.16 to 0.48): 0.3% BN(95% CI: 0.15 to 0.49) and 4.2% EDNOS (95% CI: 2.04 to 6.34) 34 .Incidence was greater in women aged 15 to 19 years: they constitute approximately 40%of identified cases in studies both in the US and Europe 30, 31, 33 . There are very few studies thatreport data on AN in prepubertal children or in adults 31 . There are also scarce studies thatpresent incidence data of AN in men. Of all the aforementioned studies, we can conclude thatincidence is lower than 1 per 100,000 inhabitants/year 33 . All these sources establish an eatingdisorder prevalence ratio of 1 to 9 in males versus women.Table 1. Studies on the prevalence of eating disorders in adolescent females in SpainStudy NAge(years)AN(%)BN(%)EDNOS(%)EDs(%)Madrid, 1997 24Morandé G and Casas J.723 15 0.69 1.24 2.76 4.69Zaragoza, 1998 26Ruiz P et al.2,193 12-18 0.14 0.55 3.83 4.52Navarra, 2000 27Pérez-Gaspar M et al.2,862 12-21 0.31 0.77 3.07 4.15Reus, 2008 29Olesti M et al.551 12-21 0.9 2.9 5.3 9.136CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
Table 2. Studies on the prevalence of eating disorders in adolescent males and females in SpainStudyNAge(years)AN(%)BN(%)EDNOS(%)EDs(%)Madrid, 1999 25Morandé G et al.1,314 15 0.00 to 0.69 0.36 to 1.24 0.54 to 2.763.044.700.90Valencia, 2003 21Rojo L et al.544 12-18 0.00 to 0.45 0.00 to 0.41 0.77 to 4.712.915.560.77Ciudad Real, 2005 22Rodríguez-Cano T et al.1,766 12-15 0.00 to 0.17 0.00 to 1.38 0.60 to 4.86Osona (Barcelona), 2006 28Arrufat F2,280 14-16 0.00 to 0.35 0.09 to 0.44 0.18 to 2.70Madrid, 2007 23Peláez MA et al.1,545 12-21 0.00 to 0.33 0.16 to 2.29 0.48 to 2.723.716.410.601.903.490.273.435.340.6437CLINICAL 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 and 24: Binge-Eating DisorderA 9.3.3.1. A s
Page 25 and 26: D 9.GP.11. In children and adolesce
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: However, there is a need for a guid
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
Page 67 and 68: of the five dimension results in th
Page 69 and 70: 6.5. It is recommended to use quest
Page 71 and 72: 7.2. How are eating disorders class
Page 73 and 74: to help them cope with the situatio
Page 75 and 76: Other examinationsTo ascertain whet
Page 77 and 78: CLINICAL PRACTICE GUIDELINE FOR EAT
Page 79 and 80: - Initiating nutritional treatment
Page 81 and 82: 8.2. In eating disorders, what clin
Page 83 and 84: 8.3.2. Criteria for admission to da
Page 85 and 86: 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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CLINICAL PRACTICE GUIDELINE FOR EAT
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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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CPG for Eating Disorders

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