Clinical practice guidelines in psychiatry: more confusion than clarity? A critical review and recommendation of a unified guideline.

Sahoo Saddichha,Santosh K Chaturvedi

doi:10.1155/2014/828917

Sahoo Saddichha, Santosh K Chaturvedi

Open Access

https://doi.org/10.1155/2014/828917

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Abstract

The discipline of psychiatry has a plethora of guidelines, designed to serve the needs of the clinician. Yet, even a cursory glance is enough to discern the differences between the various guidelines. This paper reviews the current standard guidelines being followed across the world and proposes a unified guideline on the backbone of current evidence and practice being followed. The algorithm for pharmacological and psychosocial treatment for bipolar disorder, major depressive disorder, and schizophrenia is formulated after cross-comparison across four different guidelines and recent meta-analytical evidence. For every disorder, guidelines have different suggestions. Hence, based on the current status of evidence, algorithms have been combined to form a unified guideline for management. Clinical practice guidelines form the basis of standard clinical practice for all disciplines of medicine, including psychiatry. Yet, they are often not read or followed because of poor quality or because of barriers to implementation due to either lack of agreement or ambiguity. A unified guideline can go a long way in helping clear some of the confusion that has crept in due to the use of different guidelines across the world.

Highlights

Standard clinical practice is considered the hallmark of every clinician, which is usually dictated by adhering to certain clinical guidelines [1]
While both the APA and Maudsley prefer mood stabilizers like Lithium or Valproate as first line management, NICE and the Canadian guidelines prefer the use of atypical antipsychotics like Olanzapine (Olanz/OLZ) or Risperidone (Risp)
Guidelines have been postulated to improve clinical practice, their implementation has been difficult to achieve due to the characteristics of the guidelines themselves, such as clarity, complexity of treatment recommendations, perceived credibility, use of evidence based medicine, and sponsorship, which have been shown to affect clinicians’ acceptance of guidelines [25,26,27,28]

Summary

Introduction

Standard clinical practice is considered the hallmark of every clinician, which is usually dictated by adhering to certain clinical guidelines [1]. Guidelines should use best evidence available as well as having the flexibility of being regularly updated, without leaving any scope for ambiguity They have, the best potential for ensuring that rigorous clinical standards are maintained and “best practice” is followed by clinicians [2]. They are often not read or followed because of poor quality [3, 4] or because of barriers to implementation due to either lack of agreement or ambiguity [5]. This issue becomes even more important for trainee residents who are on their way to become consultants as they are required to adhere to guidelines while practicing, and to be fully aware of them during their clinical evaluation

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