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

ABSTRACT

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating 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.

Writing group
Pierre Beumont, Rochelle Beumont, Phillipa Hay, Daphne Beumont, Laird Birmingham, Harry Derham, Amanda Jordan, Michael Kohn, Brett McDermott, Peta Marks, Jim Mitchell, Susan Paxton, Lois Surgenor, Chris Thornton, Alison Wakefield, and Sue Weigall

Disclaimer
This document was compiled for the Royal Australian and New Zealand College of Psychiatrists (RANZCP). The information and advice it contains is based on current medical knowledge and practice as at the date of publication. It is intended as a guide only. The RANZCP accepts no responsibility for any consequences arising from relying upon the above information.

(Reprinted with permission from the Australian and New Zealand Journal of Psychiatry 2004; 38:659–670)

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