Australian and New Zealand Clinical Practice Guidelines for the Treatment of Anorexia Nervosa

School of Medicine, James Cook University, Townsville, Queensland 4811, Australia.
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.41). 10/2004; 38(9):659-70. DOI: 10.1111/j.1440-1614.2004.01449.x
Source: PubMed


BACKGROUND: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health. This CPG covers anorexia nervosa (AN). METHOD: The CGP team consulted with scientists, clinicians, carers and consumer groups in meetings of over 200 participants and conducted a systematic review of meta-analyses, randomized controlled trials and other studies. TREATMENT RECOMMENDATIONS: It is extremely difficult to draw general conclusions about the efficacy of specific treatment options for AN. There are few controlled clinical trials and their quality is generally poor. These guidelines necessarily rely largely upon expert opinion and uncontrolled trials. A multidimensional approach is recommended. Medical manifestations of the illness need to be addressed and any physical harm halted and reversed. Weight restoration is essential in treatment, but insufficient evidence is available for any single approach. A lenient approach is likely to be more acceptable to patients than a punitive one and less likely to impair self-esteem. Dealing with the psychiatric problems is not simple and much controversy remains. For patients with less severe AN who do not require in-patient treatment, out-patient or day-patient treatment may be suitable, but this decision will depend on availability of such services. Family therapy is a valuable part of treatment, particularly for children and adolescents, but no particular approach emerges as superior to any other. Dietary advice should be included in all treatment programs. Cognitive behaviour therapy or other psychotherapies are likely to be helpful. Antidepressants have a role in patients with depressive symptoms and olanzapine may be useful in attenuating hyperactivity.

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    • "Intervention research is dominated by trials of family based therapy, particularly for AN in the adolescent bracket. Even with the widespread implementation of FBTs due to clinical practice guideline recommendations (e.g., [20,80]), further well-conducted trials are still required, not only to provide a stronger evidence base for clinical recommendations, but to address significant clinical questions that remain. For example, is FBT the most effective psychological intervention for AN? Head to head trials with other validated psychological interventions adapted for the eating disorders are required. "
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    ABSTRACT: Eating disorders often develop during adolescence and young adulthood, and are associated with significant psychological and physical burden. Identifying evidence-based interventions is critical and there is need to take stock of the extant literature, to inform clinical practice regarding well-researched interventions and to direct future research agendas by identifying gaps in the evidence base.
    Full-text · Article · Feb 2014 · International Journal of Eating Disorders
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    • "Under-nutrition and its sequelae are a major consequence of Anorexia Nervosa (AN) with refeeding and restoration of nutrition status a primary aim of the initial treatment. Guidelines on the treatment of AN [1-6] highlight the importance of nutrition intervention to restore weight, and help patients normalise their eating. However, clear evidence based guidelines on the best and safest method of achieving normal body weight during inpatient treatment, are currently not available. "
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    ABSTRACT: Background Clear evidence based guidelines on the best and safest method of achieving and maintaining normal body weight during inpatient treatment of Anorexia Nervosa (AN) are currently not available. Oral feeding with food alone, high-energy liquid supplements, nasogastric feeding and parenteral nutrition all have the potential to achieve weight gain in the treatment of AN but the advantages and disadvantages of each method have not been comprehensively evaluated. A literature search was undertaken to identify papers describing feeding methods used during inpatient treatment of AN. The selection criteria searched for papers that described the feeding method; and reported weight change variables such as admission and discharge weight in kilograms, or Body Mass Index; or weight change over the course of inpatient treatment. Results Twenty-six papers were identified, describing a total of 37 samples with a mean sample size of 58.9 participants, and a range from 6 to 318. The majority (84.6%) of papers were observational cohorts and retrospective chart reviews. The most common feeding method described was nasogastric feeding and food, then high-energy liquid supplements and food. Conclusions There is limited evidence on the efficacy of feeding methods used in the refeeding and nutritional rehabilitation of AN, therefore no conclusion can be made about the most effective method of achieving weight gain during inpatient treatment. While there are a number of papers exploring this issue there is no consistency in the way the information is reported to enable comparisons between the different methods. There is an urgent need for research in this area to guide decision-making in the inpatient management, refeeding and nutritional rehabilitation of AN.
    Full-text · Article · Sep 2013 · International Journal of Eating Disorders
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    • "The psychological health promotion component covers strategies for coping with stress, body image alteration, low self-esteem, depression, and anxiety. The content of the programme incorporates expert input from eating disorder specialists and is consistent with treatment recommendations for eating disorders from different eating disorder practice guidelines, including those of the American Psychiatric Association (APA) [39], the National Institute for Clinical Excellence (NICE) [40] and the Royal Australian and New Zealand College of Psychiatrists [41,42]. Before its launch, the programme was examined in a usability test on 15 female inpatients to demonstrate its usefulness, satisfactory information quality and good interface quality. "
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    ABSTRACT: Background Eating disorders are serious mental illnesses that have a significant effect on afflicted individuals’ quality of life. Evidence has shown that they can be improved with treatment. Internet-based interventions are useful in engaging individuals with eating disorders in self-management and treatment. This study aimed primarily to identify the change in quality of life of individuals with disordered eating after participating in an open trial of an Internet-based self-help programme, and compared their quality of life at assessment with that of healthy controls. Factors affecting their quality of life were examined. Secondary outcomes related to symptom improvement were also reported. Methods This study included 194 individuals with disordered eating and 50 healthy controls. The former group was recruited from eating disorder outpatient clinics and treatment units, as well as via information disseminated through various Internet websites, while the healthy controls were recruited from university student newspapers and university campuses. The Medical Outcomes Study Short Form Survey (SF-36v2) was used to assess participants’ quality of life. Other measures were used to assess their symptoms and motivational stages of change to recover from an eating disorder. The Wilcoxon signed ranks test and one-way repeated measures ANOVA were used to identify the change in quality of life of individuals with disordered eating from baseline to 1-, 3- and 6-month follow-ups. The Mann–Whitney U test was employed to compare the difference in quality of life between participants with disordered eating and the healthy controls. Spearman rank order correlations were performed to examine the factors associated with quality of life. Results The participants with disordered eating had significantly poorer quality of life than the healthy controls in both physical and psychological domains. The factors associated with their poor quality of life included dieting behaviour, use of laxatives, severe eating disorder psychopathology, depression and anxiety. Over a six-month follow-up period, a significant number of participants engaged in self-help behaviours using the Internet-based programme. They experienced improvements in their quality of life, eating disorder psychopathology, depression severity, anxiety level and motivational stages of change. Conclusions Internet-based self-help programmes have the potential to enhance quality of life in individuals with disordered eating and could be useful adjuncts to professional treatment.
    Full-text · Article · Mar 2013 · Journal of Eating Disorders
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