CPG for Eating Disorders

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ObesityObesity as a risk factor is linked to AN and BN. It is also a mid-long term habitual stateof BED and, in this case, obesity directly influences diagnosis and treatment. Up to 6% of obesechildren present BED 124-126 .Malabsorbtion syndromesEspecially in AN, malabsorbtion syndromes, gluten-intolerance or lactose-intolerance arerisk factors for eating disorders, course and prognosis modifiers and pathologies that must betaken into account when planning a treatment diet aimed at ponderal recovery. There are noprevalence studies and the literature only yields descriptions and studies of alienated cases 127, 128 .Thyroid diseasesThyroid diseases, both hyper and hypothyroidism, are relevant in the onset, course,prognosis and treatment of eating disorders. There are no prevalence studies, only casedescription studies 129-132 .CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS54
5. Prevention of Eating DisordersKey Questions:5.1. What is the efficacy of primary prevention interventions in avoiding eatingdisorders? Are there any negative effects?Primary prevention aims to limit the incidence of disease, in this case of eating disorders,by managing causes and exposure to risk factors or the patient’s increased resistance to these.Clearly, the first step to establish primary prevention measures is to identify relevant exposuresand assess their impact on the patient’s and the population’s risk of developing the disease.Specific primary prevention interventions for the most frequent eating disorders can beclassified in the following 5 types: psychoeducational, media literacy, dissonance-inductiontechniques, and interventions focused on eliminating eating disorder risk factors andstrengthening the host.In order to implement primary prevention measures there are two strategies, which oftencomplement each other: the population strategy and the high-risk strategy. The populationstrategy is general and is aimed at the entire population with the objective of reducing its averagerisk. The high-risk strategy is individual and is aimed at those people who most need it,meaning the most vulnerable individuals or those presenting additional risk as a consequence ofbeing exposed to certain risk factors. In the case of eating disorders, groups are considered ofrisk due to their age (adolescence), sex (female) or engagement in risk activities, be it as a hobbyor at a professional level (gymnasts, athletes, models, ballerinas, skaters, elite athletes, etc.) 133 .5.1. What is the efficacy of primary preventioninterventions in avoiding eating disorders? Are thereany negative effects?In order to respond to these questions, 4 high quality (1++) quantitative SRSE ormetaanalysis (MA) on eating disorder prevention programmes have been identified.Of the four MAs, one focuses the review on children and adolescents and only includesRCT 134 ; another one focuses on reviewing RCT and quasi-experimental studies (Q-RCT) onInternet-based prevention programmes 135 ; the others perform a general review of the topic,including RCT and quasi-experimental studies 136 . The potential iatrogenic effect (negativeimpact) of primary prevention programmes was another objective of two of these 4 MAs 134, 136 .The MA conducted by Stice E, et al. (2007) 137 includes all studies considered in the MAcarried out by Newton MS and Ciliska D published in 2006 135 ; 24/46 studies included in the MAconducted by Cororve FM, et al. (2006) 136 ; 10/12 studies included in the fourth MA conductedCLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS55
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Clinical Practice Guidelinefor Eati
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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
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Page 33 and 34: 1. IntroductionBackgroundThe develo
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Page 39 and 40: 2. Scope and ObjectivesTarget Popul
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Page 53: accompany eating disorders. However
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Page 75 and 76: Other examinationsTo ascertain whet
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Page 91 and 92: 9.2. Nutritional Counselling (NC)9.
Page 93 and 94: Recommendations(See recommendations
Page 95 and 96: Anorexia nervosaRecommendationsD 9.
Page 97 and 98: PSYCHOLOGICAL THERAPIESIn this sect
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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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