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Schizophrenia practice guidelines: international survey and comparison

Department of Psychiatry and Psychotherapy, Heinrich Heine University, Düsseldorf

Stefan Weinmann, MD, DrPH

Department of Psychiatry II, University of Ulm, Germany

Norman Sartorius, MD

Department of Psychiatry, University of Geneva, Switzerland

Wolfgang Rutz, MD, PhD

Unit for Psychiatry and Health Promotion, Academic University Hospital, Uppsala, Sweden

John S. McIntyre, MD

Unity Health System, Department of Psychiatry and Behavioral Health, Rochester, New York, USA

Correspondence: Professor Wolfgang Gaebel, Department of Psychiatry and Psychotherapy, Heinrich Heine University Düsseldorf, Bergische Landstrasse 2, D-40629 Düsseldorf, Germany. E-mail: Wolfgang.Gaebel{at}uni-duesseldorf.de

Declaration of interest W.G. is one of the editors of the German schizophrenia guideline (from 1998); J.M. is the Chairman of the US Steering Committee on Practice Guidelines. Funding detailed in Acknowledgements.

Background Schizophrenia guidelines differ considerably in methodology and content.

Aims To systematically compare national schizophrenia guidelines from different countries.

Method An international survey was conducted on guideline development and a methodological comparison was made using a validated guideline appraisal instrument (the Appraisal Guideline Research and Evaluation Europe).

Results The methodological quality of many schizophrenia guidelines was at best moderate. Few guidelines had included key stakeholders in their development process. Although pharmacotherapy recommendations were similar, there were strong variations in the type of psychosocial interventions recommended.

Conclusions The methodological quality of guidelines has a strong influence on their applicability. However, the lack of financial means to develop and implement guidelines is a serious problem. Independent international organisations could contribute to defining a core set of unbiased schizophrenia treatmentrecommendations. In countries with a shortage of resources, this could be a basis for adaptation to different cultural and economic backgrounds in collaboration with stakeholders.

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