Lone Baandrup1, Jesper Østrup Rasmussen2, Louise Klokker3, Stephen Austin4, Thomas Bjørnshave5, Vibeke Fuglsang Bliksted6, Anders Fink-Jensen7, Allan Hedegaard Fohlmann8, Jens Peter Hansen9, Malene Kristine Nielsen10, Karl Erik Sandsten11, Vilhelm Schultz7, Susanne Voss-Knude7, Merete Nordentoft12. 1. a Danish Health and Medicines Authority and Mental Health Centre Glostrup , Denmark . 2. b Danish Health and Medicines Authority , Denmark . 3. c Danish Health and Medicines Authority and the Parker Institute, Bispebjerg and Frederiksberg Hospital , Denmark . 4. d Mental Health Centre Nordsjælland , Denmark . 5. e General Practice , Aars , Denmark . 6. f Aarhus University Hospital , Risskov , Denmark . 7. g Mental Health Centre Copenhagen , Denmark . 8. h Frederiksbergpsykologen , Frederiksberg , Denmark . 9. i Mental Health Services, Region of Southern Denmark and Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark . 10. j Danish Health and Medicines Authority , Copenhagen , Denmark . 11. k Mental Health Centre Hvidovre , Denmark , and. 12. l Danish Health and Medicines Authority, Mental Health Centre Copenhagen and Institute of Clinical Medicine, Faculty of Health Science, University of Copenhagen , Denmark.
Abstract
BACKGROUND AND AIM: The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key issues. METHODS: Systematic literature searches were performed stepwise for each review question to identify relevant guidelines, systematic reviews/meta-analyses, and randomized controlled trials. The quality of the body of evidence for each review question was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Clinical recommendations were developed on the basis of the evidence, assessment of the risk-benefit ratio, and perceived patient preferences. RESULTS: Based on the identified evidence, a guideline development group (GDG) recommended that the following interventions should be offered routinely: antipsychotic maintenance therapy, family intervention and assertive community treatment. The following interventions should be considered: long-acting injectable antipsychotics, neurocognitive training, social cognitive training, cognitive behavioural therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence was available, the GDG agreed on a good practice recommendation. CONCLUSIONS: The implementation of this guideline in daily clinical practice can facilitate good treatment outcomes within the population of patients with schizophrenia and complex mental health needs. The guideline does not cover all available interventions and should be used in conjunction with other relevant guidelines.
BACKGROUND AND AIM: The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key issues. METHODS: Systematic literature searches were performed stepwise for each review question to identify relevant guidelines, systematic reviews/meta-analyses, and randomized controlled trials. The quality of the body of evidence for each review question was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Clinical recommendations were developed on the basis of the evidence, assessment of the risk-benefit ratio, and perceived patient preferences. RESULTS: Based on the identified evidence, a guideline development group (GDG) recommended that the following interventions should be offered routinely: antipsychotic maintenance therapy, family intervention and assertive community treatment. The following interventions should be considered: long-acting injectable antipsychotics, neurocognitive training, social cognitive training, cognitive behavioural therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence was available, the GDG agreed on a good practice recommendation. CONCLUSIONS: The implementation of this guideline in daily clinical practice can facilitate good treatment outcomes within the population of patients with schizophrenia and complex mental health needs. The guideline does not cover all available interventions and should be used in conjunction with other relevant guidelines.
Entities:
Keywords:
Clinical guideline; GRADE; meta-analysis; quality of evidence; schizophrenia; strength of recommendations
Authors: Syune Hakobyan; Sara Vazirian; Stephen Lee-Cheong; Michael Krausz; William G Honer; Christian G Schutz Journal: J Clin Med Date: 2020-07-28 Impact factor: 4.241