Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa.
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).


METHODS
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.


CONCLUSIONS
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.
Beumont
Pierre
P
School of Medicine, James Cook University, Townsville, Queensland 4811, Australia. Phillipa.hay@jcu.edu.au
Hay
Phillipa
P
Beumont
Daphne
D
Birmingham
Laird
L
Derham
Harry
H
Jordan
Amanda
A
Kohn
Michael
M
McDermott
Brett
B
Marks
Peta
P
Mitchell
Jim
J
Paxton
Susan
S
Surgenor
Lois
L
Thornton
Chris
C
Wakefield
Alison
A
Weigall
Sue
S
D000856:Anorexia Nervosa / Q000628:therapy*; D001315:Australia; D001828:Body Image; D015928:Cognitive Behavioral Therapy; D004358:Drug Therapy / Q000379:methods; D006801:Humans; D008605:Mental Health Services / Q000592:standards*; D009520:New Zealand; D011570:Psychiatry / Q000592:standards*; D012649:Self Concept; D015430:Weight Gain; D015431:Weight Loss