CPG for Eating Disorders

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