Fallas de los dientes de engranajes:

Population Interventions Comparison of interventions Outcomes

1. Hay PPJ, Bacaltchuk J, Byrnes RT, Claudino AM, Ekmejian AA, Yong PY. Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa. 2003. Assessed as up-todate: Feb 11, 2008

Older adolescents and adults (aged >16 years) of any age or gender with AN (DSM-III, DSM-III-R, DSM- IV diagnostic criteria (APA 1994); ICD-10 (WHO 1992); Russell (1970).

Individual psychotherapies (time-limited), IPT, CAT, CBT.

The individual psychotherapies were compared to: 1. Usual treatment 2. Dietary advice 3. Waiting list.

Primary outcomes

Weight restoration to within the normal weight range (e.g. BMI) Weight, mean BMI (weight in kg/height in metres, squared) at end of treatment.

Secondary outcomes

Recovery according to the Morgan 1975 narrow scale of: 1. A good outcome, namely normal body weight with normal menstruation or

2. Intermediate outcome, namely normal body weight with no menstruation

Mean eating disorder symptom scores

Proportion of study drop-outs or non-completers for any reason or any adverse event or experience

Patient satisfaction ratings

Level of side effects or negative effects of therapy General psychiatric symptomatology

Level of depression Level of interpersonal function. 2. Fisher CA, Hetrick SE, Rushford N. Family therapy for anorexia nervosa. 2010. Assessed as up-to-date: Jul 31, 2008

Patients of any age or sex with a primary clinical diagnosis of AN either or both purging or restricting subtype based on DSM (APA 1994) or ICD criteria (WHO 1992) or clinicians’ judgement, of any severity.

The main types of family therapy have been considered:

- Structured family therapy - Systemic family therapy - Strategic family therapy

- Family-based therapy and its variants - Systemic behavioral family therapy - Other types of therapies, including approaches using family therapy, but are less specific

The family therapy was compared to:

1. Standard treatment or usual 2. Educational interventions 3. Psychological interventions (family therapy or others types of psychological interventions)

Primary outcomes

1. Remission (by DSM or ICD or standardised scale measure for remission)

2. All cause mortality Secondary outcomes 1. Relapse 2. Dropout 3. Family functioning 4. General functioning 5. Cognitive distortion 6. Weight

3. Hay PPJ, Bacaltchuk J, Stefano S, Kashyap P. Psychological treatments for bulimia nervosa and binging. 2009. Assessed as up-to-date: May 31, 2007 Adults (aged >16 years)

with bulimia nervosa, binge eating and/or EDNOS.

1. Cognitive behaviour psychotherapy or CBT: a psychotherapy that uses the specific techniques and model of CBT-BN, as described by Fairburn and colleagues (Fairburn 1993b), but not necessarily the number of sessions or specialist expertise. In trials of bulimia nervosa, data were analysed for both the broader “CBT” and the strict “CBT-BN”.

The CBT was compared to: 1. No treatment, to include waiting list

2. Other psychotherapy approaches

- Nutritional counselling (as an adjunct to a psychological treatment) - IPT - Hypnotherapy - Psychoanalytic or psychodynamic psychotherapy - Any other psychotherapy including BWLT (for overweight binge eaters

- PSH

Primary outcomes

1. 100% abstinence from binge eating at the end of therapy 2. Mean bulimic symptom scores either from an eating disorders symptom rating scale, or the estimated binge frequency at end of therapy

Secondary outcomes

1. Side effects or negative effects of therapy

2. Proportion of non-completers due to any reason, and those due to adverse events

3. Mean scores at end of therapy on any scale measuring depressive symptoms.

4. General psychiatric symptomatology 5. Improvement in interpersonal functioning 6. Weight

7. Patient satisfaction by a validated questionnaire or interview schedule

...Continuation

Appendix 2. The main characteristics of the Cochrane Systematic Reviews

Population Interventions Comparison of interventions Outcomes

4. Hay PPJ, Claudino AM, Kaio MH. Antidepressants versus psychological treatments and their combination for bulimia nervosa. 2001. Avaliado como atualizado: 12 de agosto de 2001. Assessed as up-to-date: Aug 12, 2001

People with bulimia nervosa defined by clinical state description or diagnosed by Russell’s (Russell 1979), DSM or ICD criteria. Participants with both purging and nonpurging type bulimia nervosa, as defined in DSM-IV (APA 1994), were included. Antidepressants CBT Cognitive therapy Behaviour therapy Psychodynamic/psychoanalytic-oriented therapy Interpersonal therapy Supportive therapy Nutritional counselling

The psychological treatments were compared to: 1. Antidepressants 2. Combination (psychological treatments plus antidepressants)

A. Efficacy

(i) The number of people per treatment group who did not show a remission in the bulimic symptoms, defined as 100% reduction in binge or purge episodes from baseline to endpoint

(ii) The number of people per treatment group who did not show a clinical improvement in the bulimic symptoms, defined as at least 50% reduction in binge or purge episodes from baseline to endpoint

(iii) The average difference in bulimic symptoms at endpoint B. Comorbidity

(i) Average difference in the severity of depressive symptoms at the end of the trial

C. Acceptability of the treatment

(i) Number of people per treatment group dropping out during the trial for any cause.

5. Perkins SSJ, Murphy RRM, Schmidt UUS, Williams C. Self-help and guided self-help for eating disorders. 2006. Assessed as up-to-date: May 23, 2006 People of any age, gender

or chronicity with AN or bulimia nervosa or binge eating or EDNOS (DSM, ICD, Russell, 1979).

Manuals PSH - only materials and manuals GSH - materials more guide therapist.

The PSH and GSH were compared to: 1.Waiting list

2. Other formal psychological therapies

3. PSH versus GSH

Primary outcomes: (a) Abstinence from bingeing (b) Abstinence from purging (c) Weight (BMI) Secondary outcomes:

(a) Eating disorder symptomatology

(b) Weight restoration (BMI) to within normal range

(c) Proportion of non-completers or dropouts due to any reason, and those due to adverse events

(d) Patient satisfaction

(e) Adherence to self-help (e.g. percentage of material read; percentage of homework tasks completed)

(f) Side effects or negative effects of therapy (g) Additional help seeking

(h) General psychiatric and mental state symptomatology (i) Improvement in interpersonal functioning

(j) Mean scores on any scale measuring depressive symptoms (k) Health care cost.

AN: anorexia nervosa; DSM: Diagnostic and Statistical Manual of Mental Disorders; ICD: International Classification of Diseases; IPT: interpersonal psychotherapy; CAT: cognitive analytic therapy; CBT: cognitive behavioural therapy; BMI: body mass index; EDNOS: eating disorders not otherwise specified; CBT-BN: cognitive behavioural therapy for bulimina nervosa; BWLT: behavioural weight loss treatment; PSH: pure self-help; GSH: guided self-help.