Adherence of Psychopharmacological Prescriptions to Clinical Practice Guidelines in Patients

Supplementary S1. Psychopharmacological recommendations for patients with eating behavior disorders

Anorexia Nervosa APA (2006) recommendations Reason for non-adherence “Psychopharmaceuticals should be used in conjunction with psychosocial interventions, not as a sole “Psychopharmaceutical in or primary treatment for patients with AN”. monotherapy” “SSRIs do not appear to confer advantage regarding weight restoration, core ED pathology, and/or “Psychopharmaceutical with comorbid psychiatric symptoms in malnourished patients with AN”. controversial effectiveness” “Bupropion should be avoided for treatment of core ED pathology and/or comorbid psychiatric “Psychopharmaceutical with symptoms because of the increased risk of seizures. TCA and MAOI should be avoided because of the risk of adverse effects” potential lethality and toxicity in overdose”. “Antianxiety agents used selectively before meals may be useful to reduce patient’s anticipatory “Psychopharmaceutical with anxiety before eating, but because these patients have a high propensity to become dependent on risk of abuse/dependence” benzodiazepines, these medications should not be used”. “Second-generation antipsychotics, particularly olanzapine, risperidone and quetiapine, may be “Not first-choice useful in patients with severe unremitting resistance to gaining weight and severe obsessions”. antipsychotic” NICE (2004)/SMHC (2009) recommendations Reason for non-adherence “Psychopharmaceutical in “Psychopharmaceuticals should not be used as the sole or primary treatment for AN”. monotherapy” “Given the risk of heart complications presented by patients with AN, prescription of drugs whose “Psychopharmaceutical with adverse effects may affect cardiac function must be avoided for treatment of core ED pathology and/or risk of adverse effects” comorbid psychiatric symptoms”.* Bulimia Nervosa APA (2006) recommendations Reason for non-adherence “Antidepressants are the first-choice psychopharmaceuticals to reduce the frequency of binge- “Not first-choice eating/purging, reduce comorbid psychiatric symptoms, and prevent relapse”. psychopharmaceutical” “SSRIs are the antidepressants of first choice for the treatment of BN in terms of acceptability, “Not first-choice tolerability, and reduction of binge-eating/purging”. antidepressant” “Among SSRI antidepressants, fluoxetine is the first-choice drug for the treatment of BN in terms of “Not first-choice SSRI” acceptability, tolerability, and reduction of binge-eating/purging”. “Doses of SSRI used to reduce binge-eating/purging are higher than those used for treatment of “Inadequate maintenance dose” depression (e.g., 60-80 mg/day of fluoxetine)”.** “For relapse prevention, antidepressants may be continued for at least 9 months”. “Inadequate duration” “TCA, MAOI and bupropion should be avoided for treatment of core BN pathology and/or comorbid psychiatric symptoms because of increased adverse effects risk”. “For patients who require a mood-stabilizing drug for treatment of core BN pathology and/or “Psychopharmaceutical with comorbid psychiatric symptoms, lithium and valproic acid should be avoided because they induce risk of adverse effects” weight gain in patients and may result in non-adherence. Levels of lithium carbonate can shift markedly with rapid volume changes that accompany binging and purging”. NICE (2004)/SMHC (2009) recommendations Reason for non-adherence “Pharmacological treatments other than antidepressants are not recommended as first-choice “Not first-choice treatment of BN”. psychopharmaceutical” “SSRIs are the antidepressants of first choice for treatment of BN in terms of acceptability, tolerability, “Not first-choice and reduction of binge-eating/purging”. antidepressant” “Among SSRI antidepressants, fluoxetine is the first-choice drug for treatment of BN, in terms of “Not first-choice SSRI” acceptability, tolerability, and reduction of binge-eating/purging”. “The dose of fluoxetine used to reduce binge-eating/purging is higher than the dose used for treatment “Inadequate maintenance dose” of depression (60 mg/day)”.** Eating Disorder Not Otherwise Specified Patients with EDNOS should be evaluated according to the ED they resemble most (AN or BN) AN: Anorexia Nervosa; APA: American Psychiatric Association; BN: Bulimia Nervosa; ED: Eating Disorder Behavior, EDNOS: Eating Disorder Not Otherwise Specified; MAOI: Monoamine Oxidase Inhibitors; NICE: National Institute of Clinical Excellence; SMHC: Spanish Ministry of Health and Consumption; SSRI: Selective Serotonin Reuptake Inhibitors; TCA: Tricyclic antidepressants. *Psychopharmaceuticals with risk of heart disorders (QT-prolongation or arrhythmia): antipsychotics (except aripiprazole, olanzapine, zuclopenthixol), TCA, MAOI, lithium, citalopram, escitalopram, and venlafaxine [21]. **The maximum maintenance doses of SSRI recommended to treat depression were specified in the information sheets for these drugs, based on pivotal clinical trials: fluoxetine (60 mg/day), fluvoxamine (300 mg/day), paroxetine (50 mg/day), sertraline (200 mg/day), citalopram (40 mg/day), and escitalopram (20 mg/day). 2