CPG for Eating Disorders

Summary of the Evidence(See also the summary of the evidence for psychological treatment)CPG 30SRSE 311++There is limited evidence to determine that CBT is more acceptable than NC forAN inpatients after weight restoration (1 RCT; N=33; Pike, 2003) 210 .Psychological interventions do not usually produce adverse effects in treatedpatients.Recommendations(See recommendations 9.GP.1. to 9.GP.11.)9.3.2. Bulimia nervosa9.3.2.1. What is the efficacy of CBT in patients with BN?The source of evidence to answer this question has been NICE’s CPG (2004) 30 , whichdescribes evidence based on outcome variables. It is also based on high-quality (1++) SRSE,one elaborated by the AHRQ of the US (2006) 31 and a further more recent publication byShapiro, et al. (2007) 211 , where six new quality (1++ and 1+) RCT were identified. Theupdated search subsequently yielded two more RCT.Variable: reduction / remission of binge-eating and purgingThere is strong evidence that points to a higher efficacy of CBT-BN vs. wait-list interms of remission in adults with BN by the end of treatment (3 RCTs; N=136;Griffiths, 1994 217 ; Lee, 1986 218 ;Treasure, 1999 219 ; RR: 0,73; 95% CI: 0.61 to 0.88;NNT:4; 95% CI: 3 a 9).There is strong evidence that indicated the efficacy of CBT-BN vs. wait-list in terms ofthe frequency of binge-eating (5 RCTs: N=185; Griffiths, 1994 217 ; Lee, 1986 218 ;Treasure, 1999 219 ; Freeman, 1988 220 ; Wolf, 1992 221 ; SMD: -0.75 95% CI: -1.05 to -0.44)and the frequency of purging in adults by the end of treatment (6 RCTs; N=192;Griffiths, 1994 217 ; Lee, 1986 218 ; Freeman, 1988 220 ; Wolf, 1992 221 ; Agras, 1989 222 ;Leitenberg, 1988 223 ; SMD according to the random effects model: -1.00; 95% CI:-1.63to -0.36).It is not likely that CBT-BN is more effective than BT in reducing the frequency ofbinge-eating (SMD:-0.11; 95% CI:-0.45 to 0.24) and purging episodes by the end oftreatment (SMD: 0.08; 95% CI: -0.27 to 0.42) (3 RCTs; N=131; Fairburn, 1991 224 ;Freeman, 1988 220 ; Wolf, 1992 221 ).There is not sufficient evidence that CBT-BN-ERP is superior to CBT-BN in terms ofremission of binge-eating (2 RCTs; N=53; Cooper, 1995 225 ;Wilson, 1991 226 ; RR: 0.97;RCT1 ++RCT1 ++RCT1 ++RCT1 ++99CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS