Schizophrenia guidelines across the world: A selective review and comparison

Abstract

Treatment guidelines provide evidence-based recommendations to assist practitioners in specific clinical situations. They are a major tool to assure and enhance treatment quality and to overcome existing disparities. However, guideline quality itself varies and needs to be considered. Based on a former review, schizophrenia guidelines with high methodological quality were identified and examined regarding updated versions. Five guidelines were selected, of which three updates have been newly evaluated with the AGREE instrument. In addition, clinical content regarding seven core topics in schizophrenia treatment decisions was compared. Guideline quality on average is good, with highest AGREE scores for the NICE guideline. Updating of the German guideline resulted in noticeable quality improvements. Regarding content, recommendations largely correspond in five areas across guidelines, whereas discrepancies or vagueness exist in two areas due to newly emerging (drug choice) or still restricted evidence (duration of antipsychotic treatment). There are increasing efforts to develop guidelines with improved quality. Also, there is a need to equalize and improve healthcare quality across countries. Since many formal and content-related issues are ‘universal’, development of trans-national guidelines seems indicated. Nevertheless, core guideline recommendations should be adapted to regional conditions using available tools for adaptation.

Declaration of interest: This study was conducted within the framework of the German Research Network on Schizophrenia, funded by the German Federal Ministry for Education and Research BMBF grants 01 GI 9932 and 01 GI 0232. Wolfgang Gaebel received symposia support from Janssen-Cilag, Neuss/Germany, and Lilly Deutschland, Bad Homburg/Germany, and is a member of the advisory board of Lundbeck International Neuroscience Foundation (LINF), Denmark. Thomas Wobrock is a member of a speakers’ bureau for Alpine Biomed, AstraZeneca, Eli Lilly, Essex and Janssen-Cilag, and has accepted speaker's fees and/or expenses and hospitality from AstraZeneca, Bristol-Myers-Squibb, Eli-Lilly, Janssen Cilag, Novartis and Pfizer, and Sanofi-Synthelabo, and received a research grant from AstraZeneca. In addition Wolfgang Gaebel and Thomas Wobrock are authors of the German schizophrenia guideline. The authors alone are responsible for the content and writing of the paper.