CPG for Eating Disorders

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(Adopted from recommendation 7.5.3.3 of the NICE CPG).D 9.GM.9. Patients who vomit habitually must have regular dental check-ups and beprovided with dental hygiene advice. (Adapted from recommendations7.5.3.4 and 7.5.3.5 of the NICE CPG).CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS96
PSYCHOLOGICAL THERAPIESIn this section scientific evidence on the efficacy and safety of a series of psychologicaltherapies studied in patients with eating disorders is described. Only randomised controlledtrials (RCT) of sufficient quality have been included. The following therapies have beenassessed: cognitive-behavioural therapy, self-help and guided self-help, interpersonal therapy,family therapy (systemic or unspecified), psychodynamic therapy and behavioural therapy.9.3. Cognitive-Behavioural Therapy (CBT)9.3.1. Anorexia nervosa9.3.1.1. What is the efficacy of CBT in patients with AN?The answer is based on the NICE CPG (2004) 30 . High-quality (1++) SRSE have been taken intoaccount, one elaborated by the AHRQ of the US (2006 31 ) and a further one recently published byBulik, et al. (2007) 202 where the same RCTs are included. The updated search has not yieldedany new evidence.Scientific EvidenceIn an RCT (Channon, 1989; UK 215 ), CBT (N=8; mean age=21.6 years) was compared tobehavioural therapy (BT) (N=8; mean age=24.1 years) and a control group (standardtreatments) (N=8; mean age=25.8 years) in women with AN (mean age range: 21.6-25.8years) treated on an outpatient basis for 12 months. At 6 months of treatment, CBT wasmore effective than BT in improving psychosexual functioning. In contrast, BT wasmore effective than CBT in improving the menstrual cycle. At one year of treatment,BT was more effective than the other two treatments in restoring patients’ weight.In a further RCT (Pike, 2003; USA) 210 , CBT (N=18) was compared to NC (N=15) inwomen (18-45 years) with AN who had been under inpatient treatment for 12 months.After weight restoration, a lower percentage of failures, a higher percentage of positiveresults and a longer period of time until recurrence was reported in the group thatreceived CBT. However, one of the limitations of the study was the fact that manypatients had received concomitant antidepressant treatment.In the third RCT (McInstosh, 2005; New Zealand) 216 , CBT (N=19) was compared to IPT(N=21) and non-specific supportive clinical management (NSCM) (N=16), in women(17-40 years) with AN who were treated on an outpatient basis for 20 weeks. Nonspecificsupportive clinical management (NSCM) was more effective than IPT inimproving patients’ general behaviour and in dietary restraint at 20 weeks of treatmentand was also more effective than CBT in improving general behaviour at 20 weeks.CBT was superior to IPT in improving dietary restraint at 20 weeks.RCT1 +RCT1 +RCT1 +97CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS
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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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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
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Page 57 and 58: (causal factors). Participants in t
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Page 61 and 62: MA 1341++MA 1341++No definitive con
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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
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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
Page 95: Anorexia nervosaRecommendationsD 9.
Page 99 and 100: Summary of the Evidence(See also th
Page 101 and 102: There is limited evidence to sugges
Page 103 and 104: In an RCT (Wilson, 2002; USA) 234 C
Page 105 and 106: SRSE 2401++SRSE 2401++CBT treatment
Page 107 and 108: In an RCT (Bulik, 1998) 236 the ove
Page 109 and 110: Evidence indicates that it is unlik
Page 111 and 112: A 9.3.3.1. Adult patients with BED
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Page 115 and 116: Variable: reduction / remission of
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Page 120 and 121: Scientific EvidenceThere is insuffi
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Page 124 and 125: Summary of the Evidence(See summary
Page 126 and 127: In an RCT (Lock, 2005) 271 , 20% of
Page 132 and 133: elaborated by the AHRQ of the US (2
Page 134 and 135: SUMMARY OF THE EVIDENCE FORPSYCHOLO
Page 136 and 137: D 9.GP.6. For patients with AN who
Page 138 and 139: PHARMACOLOGICAL TREATMENTIn this se
Page 140 and 141: 9.9.1.2. What is the safety of anti
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Page 144 and 145: 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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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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