Adolescents with bulimia nervosa may be treated with CBT-BN adapted as needed to suit their age, circumstances and level of development and including the family as appropriate. For inpatients with anorexia nervosaa structured symptom-focused treatment regimen with the expectation of weight gain should be provided in order to achieve weight restoration.
There is a very limited role for the inpatient treatment of bulimia nervosa. Health care professionals assessing children and adolescents with eating disorders should be alert to indicators of abuse emotional, physical and sexual and should remain so throughout treatment.
The involvement of a physician or paediatrician with expertise in the treatment of physically at-risk patients with anorexia nervosa should be considered for all individuals who are physically at risk.
Family members including siblings, should normally be included in the treatment of children and adolescents with eating disorders.
Any beneficial effects will be rapidly apparent. Suitably adapted psychological treatments should be offered to adolescents with persistent binge eating disorder. Pharmacological interventions for anorexia nervosa There is a very limited evidence base for the pharmacological treatment of anorexia nervosa.
Managing weight gain 4. As a possible first step, patients with bulimia nervosa should be encouraged to follow an evidence-based self-help programme. This includes the determination of the need for emergency medical or psychiatric assessment.
This requires both early identification and intervention. In patients with anorexia nervosa at risk of cardiac complications, the prescription of drugs with side effects that may compromise cardiac function should be avoided. Interventions may include sharing of information, advice on behavioural management and facilitating communication.
Research recommendations The following research recommendations have been identified to address gaps in the evidence base: For people with bulimia nervosathe effective dose of fluoxetine is higher than for depression 60 mg daily.
Pregnant women with eating disorders require careful monitoring throughout the pregnancy and in the post-partum period. When providing psychological treatments for patients with binge eating disorderconsideration should be given to the provision of concurrent or consecutive interventions focusing on the management of comorbid obesity.
In addition to the provision of information, family and carers may be informed of self-help groups and support groups and offered the opportunity to participate in such groups where they exist. Caution should be exercised in the use of medication for comorbid conditions such as depressive or obsessive-compulsive features as they may resolve with weight gain alone.
Management of anorexia nervosa in primary care 4. This may be sufficient treatment for a limited subset of patients. Health care professionals without specialist experience of eating disordersor in situations of uncertainty, should consider seeking advice from an appropriate specialist when contemplating a compulsory admission for a patient with anorexia nervosa regardless of the age of the patient.
Whenever possible patients should be engaged and treated before reaching severe emaciation.
The length of outpatient psychological treatment and physical monitoring following inpatient weight restoration should typically be at least 12 months. If the prescription of medication that may compromise cardiac functioning is essential, ECG monitoring should be undertaken.
The guideline applies to adults, adolescents and children aged 8 years and older. Health care professionals should also recognise the consequent demands and challenges this presents.
Getting help early There can be serious long-term consequences to a delay in obtaining treatment. Family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa.
This is primarily concerned with the management of suicide risk or severe self-harm. For patients with bulimia nervosa who are at risk of suicide or severe self-harm, admission as an inpatient or a day patient or the provision of more intensive outpatient care, should be considered.
For patients with anorexia nervosaif during outpatient psychological treatment there is significant deterioration, or the completion of an adequate course of outpatient psychological treatment does not lead to any significant improvement, more intensive forms of treatment for example, a move from individual therapy to combined individual and family work or day care, or inpatient care should be considered.
No drugs, other than antidepressants, are recommended for the treatment of bulimia nervosa. Health care professionals should advise people with eating disorders and osteoporosis or related bone disorders to refrain from physical activities that significantly increase the likelihood of falls.
Total parenteral nutrition should not be used for people with anorexia nervosaunless there is significant gastrointestinal dysfunction. A range of drugs may be used in the treatment of comorbid conditions but caution should be exercised in their use given the physical vulnerability of many people with anorexia nervosa.
This agreement should be in writing where appropriate using the care programme approach and should be shared with the patient and, where appropriate, his or her family and carers.
Therapies to be considered for the psychological treatment of anorexia nervosa include cognitive analytic therapy CATcognitive behaviour therapy CBTinterpersonal psychotherapy IPTfocal psychodynamic therapy and family interventions focused explicitly on eating disorders.
Common elements of the psychological treatment of anorexia nervosa 4. Treatment of both subthreshold and clinical cases of an eating disorder in people with diabetes is essential because of the greatly increased physical risk in this group.
In assessing whether a person has anorexia nervosaattention should be paid to the overall clinical assessment repeated over timeincluding rate of weight loss, growth rates in children, objective physical signs and appropriate laboratory tests.
Medication should not be used as the sole or primary treatment for anorexia nervosa.New screening guidelines for eating disorders.
McBride DL(1). Author information: (1)Kaiser Permanente Oakland Medical Center, Allston Way, Berkeley, CAUSA. [email protected] Clinical Practice Guideline, eating disorders, evidence-based review Introduction This guideline for the clinical management of eating disorders is a project of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).
The guideline represents. Identify the difference between screening for eating disorders, and diagnosing an eating disorder. And is recommended for us as a screening tool by primary care providers by the American Academy of Family Physicians, () and the American Medical Association ().
Treatment of Eating Disorders; Treatment of Bipolar Disorder; The National Guideline Clearinghouse is a public database of clinical practice guidelines from around the world that is maintained by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.
Guidelines must meet criteria showing they comply. The Practice Guideline for the Treatment of Patients With Eating Disorders, Third Edition, con- sists of three parts (A, B, and C) and many sections, not all of which will be equally useful for all readers.
May 20, — The Academy of Eating Disorders (AED) has published guidelines for detecting and managing eating disorders in primary care practice.Download