Sunday, December 7, 2014

New guideline for eating disorder in Australia

Recently, a new clinical guideline regarding treatment for eating disorders was published.

This guideline was developed by the Clinical Practice Guideline working group in which several specialists were participated. It confirms to DSM-5, based on newest clinical evidence. You can read the full text of the guideline on the website.

Medscape Medical News: New Eating Disorder Guidelines Released

Australian & New Zealand Journal of Psychiatry: Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders

Several elements are focused on this guideline. First, adult patients are distinguished from children, for there are many differences in the treatment strategy. In general, adult patients with eating disorders are difficult to treat than children. The evidence to direct proper way of treatment is limited. Instead, it is well known that family therapy is beneficial to child patients with eating disorders.

Second, the standard of admission for patients with anorexia nervosa is clearly defined. If Body Mass Index (BMI) becomes less than 14, the patient should be admitted to a psychiatric ward. When BMI > 12, medical admission is indicated. I agree with this suggestion, because low body weight is sometimes fatal. In addition, patients with low body weight are hardly responsive to psychotherapy, especially in an outpatient unit.

Least restrictive policy is emphasized in this guideline, although occasional necessity of involuntary treatment is also referred. Motivation enhancement is recommended, but its effectiveness has not entirely guaranteed. Compulsory treatment is a big issue to discuss the treatment for anorexia nervosa. I expected more definitive description about this matter.

In this guideline, description about avoidant/restrictive food intake disorder (ARFID) is almost empty. It is a new disorder referred in DSM-5 for the first time. Indeed, there have been only few articles found studying this disease. I saw a couple of patients suspected to have such disorders, who were diagnosed as anorexia nervosa or obsessive compulsive disorder. Further research is needed to clarify the nature and management of ARFID.

I think this guideline is sophisticated and concise. Though cultural difference should be considered to utilize this guideline in foreign countries, it may be useful for many practitioners.

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