CPG for Eating Disorders

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3) To respond to those questions unanswered by the CPGs, SRSE and assessment reports(AR) included or to update them, a search for randomised controlled trials (RCTs) wasperformed in Pubmed/Medline between March 2007 and October 2007.4) The search for CPG/SRSE/AR in Tripdatabase and Pubmed/Medline was also updatedup to October 2007.5) Additional searches were carried out in Pubmed/Medline and Scopus for primaryprevention of eating disorders due to the limited information available in the documentsincluded (until June 2008). The effect of primary prevention interventions for eatingdisorders has been assessed in RCT or in SRSE of RCT.6) A search was also performed for cohort studies and prognosis of eating disorders in theScopus and Psycinfo databases during the period spanning from 2000 to 2008.7) The Ginebrina Foundation was also consulted for Medical Training and Research and thedocuments provided by the working group and the references of the documentsincluded were reviewed.– Selection of Evidence. The most relevant documents were selected by applying predefinedinclusion and exclusion criteria:• Inclusion criteria: guides, SRSE and ARs in certain languages (Spanish, Catalan, French,English and Italian) that dealt with the previously mentioned objectives. Minimumquality criteria were established for the guides, SRSE and ARs: the bibliographic basesconsulted and/or the formulation process of recommendations (ad hoc defined criteria)had to be described.• Exclusion criteria: documents/guides that were not original, unavailable (wrong referenceor electronic address), not directly related with the proposed objectives, already includedin the bibliography of other documents/guides or that didn’t comply with minimumquality criteria.Two independent reviewers examined the titles and/or summaries of the documents identified bythe search strategy. If any of the inclusion criteria were not fulfilled, the document wasexcluded. If criteria were fulfilled, the complete document was requested and evaluated in orderto decide whether it would be included or not. Discrepancies or doubts that arose during theprocess were resolved by consensus of the entire technical team.– Quality assessment of the scientific evidence. Assessment of CPG quality was performed bya trained evaluator using the AGREE 45 instrument. Guides were considered of quality whenthey were classified as Recommended in the overall assessment. For SRSE/ARs and RCT,SIGN’s methodology checklists were applied by an evaluator, following the recommendationsestablished in the MSC’s 1 CPG development manual. Classification of evidence has beencarried out using the SIGN system (See Annex 1).CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS44
– Synthesis and analysis of the scientific evidence. Different templates were used forinformation retrieval. Information regarding the main characteristics of the studies wasobtained and then synthesised in evidence tables for a subsequent qualitative analysis. Whenthe SRSE or CPGs reported the results of individual studies, these results were described in thesection “scientific evidence”.In Annex 6.2 results of the CPG’s search, selection and assessment of quality are described. InAnnex 6.3. and Annex 6.4. NICE’s CPG 30 and AHRQ’s SRSE 31 are respectively described,representing the main scientific base on which this guide is founded.– Formulation of recommendations based on formal assessment or on SIGN’s consideredjudgement. The grading of recommendations has been performed using SIGN’s system (SeeAnnex 1). Recommendations pertaining to the NICE CPG have been considered by theworking group and have been classified as: adopted (and, hence, accepted; they have simplybeen translated into Spanish) or adapted (and, hence, modified: changes have been made withthe purpose of contextualising them to our setting). Controversial recommendations or thoselacking in evidence have been resolved by the working group’s consensus. The category ofeach recommendation appears in the chapters.– Description of psychological therapies. Definitions are derived from the NICE 30 guide, fromthe SRSE where they have been assessed and from the working group itself (See Annex 4).– Description of drugs (mechanism of action and approved indications in Spain) included in theCPG. The following websites have been consulted: Spanish Drug Agency (AGEMED)(https://agemed.es) and Vademecum (http://www.vademecum.es). It is recommended to readthe technical chart of each drug before any therapeutic prescription given that the CPG onlyincludes a very brief description of each drug and does not go into depth in terms of schemes,contraindications, etc. (See Annex 4).– Legal aspects. To develop this chapter, aside from reviewing the current legislation in ourcountry, several different articles and reference documents 17, 46-49 have been consulted.– To develop patient information (See Annex 3.1.), a search has been performed for pamphletsand other documents containing information for the patient/carer both in printed and electronicformats. To this end, all documents identified in the websites of three relevant organizations(www.feacab.org, www.itacat.com and www.adaner.org) that comprise the majority ofassociations declared of public use at a national level through their different delegations andsupport groups and the material provided by the clinical coordinator have been reviewed.Following the review of these documents, a content comparison table was elaborated from whichthe table of contents was developed. Once consensus of the final version had been reached bythe working group and collaborating experts, the Association in Defence of Anorexia Nervosaand Bulimia Management (ADANER) and the Spanish Federation of Support Associations forAnorexia (FEACAB), which include most local organisations, carried out an external review,using a specifically designed questionnaire that inquired on the suitability of the informationprovided, the examples used, style and language, etc. Although this information is part of theCPG and must be delivered and explained to the patient/carer by health care professionals, wehope to edit individualised pamphlets that facilitate its dissemination.45CLINICAL 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 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: 3. MethodologyThe methodology emplo
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
Page 87 and 88: 9. Treatment of Eating DisordersThe
Page 89 and 90: An RCT (Rigaud, 2007; France) 203 c
Page 91 and 92: 9.2. Nutritional Counselling (NC)9.
Page 93 and 94: 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
Page 270 and 271:
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.
Page 284 and 285:
388. Steinhausen HC. The outcome of
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427. Finnish Medical Society Duodec
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