Schizophrenia practice guidelines: international survey and comparison
Gaebel W, Weinmann S, Sartorius N, Rutz W and McIntyre JS;
Commented by , 28 Sep 2005
Aim of the study
When the first treatment guidelines in psychiatry were presented in the late 1980s, they faced quite a bit of scepticism. This initial scepticism then turned almost into euphoria, and a large number of clinical practice guidelines were published by various national and even regional psychiatric organisations.
Since guidelines differ considerably in quality, methodology and recommendations, the authors attempted to systematically assess and compare national guidelines on the treatment of schizophrenia.
Methods
In an international survey the authors identified treatment guidelines on schizophrenia that were produced by national psychiatric associations. The quality of the documents found was then assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument.
Furthermore, the recommendations of the guidelines on different treatment questions were compared.
Results
27 guidelines from 21 countries were identified. The quality of the development process of many schizophrenia guidelines was at best medium grade. Health economic aspects were considered very rarely and only a few guideline producers had included important interest groups other than doctors in the development process.
The recommendations in terms of pharmacological treatments were similar, but the type of psychosocial interventions recommended varied significantly.
Dr Leucht's comments
The main result of the survey was that although a few excellent schizophrenia guidelines exist, most of the documents found did not meet current quality standards as assessed by the AGREE instrument.
A similar study based on even more (N = 61) psychiatric guidelines, which was not limited to schizophrenia, but focused on European psychiatric guidelines, yielded very similar results (ref. 1).
Given the enormous complexity and expenditure in time and cost necessary to develop a methodologically sound guideline, these results are not surprising. In many countries sufficient funding for guideline development does not exist.
But the question is whether each national psychiatric association really needs to develop its own set of guidelines?
Both the current authors and Stiegler et al. (ref. 1) assessed whether national particularities were considered in the guidelines, but this was done very rarely and if so then only very vaguely (ref. 1).
One solution would be an international joint project with the aim to develop shareable guidelines and thereby save costs. Essential national particularities could then be added according to requirements by the national psychiatric organisation of the respective country.
This idea has been implemented by the Guidelines International Network (G-I-N) that was founded in 2002 and consists of 52 organisations from 27 countries (ref. 2).
References
1. Stiegler M, Rummel C, Wahlbeck K, Kissling W and Leucht S. European psychiatric treatment guidelines: Is the glass half full or half empty? European Psychiatry Sep 1 2005 [Epub ahead of print]
2. Ollenschläger G, Marshall C, Qureshi S, et al. for the Board of Trustees 2002, Guidelines International Network (G-I-N). Improving the quality of health care: using international collaboration to inform guideline programmes by founding the Guidelines International Network (G-I-N). Qual Saf Health Care 2004; 13; 455-460