Jakovljević Miro
University Psychiatric Clinic Rebro, Clinical Hospital Centre Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia.
Psychiatr Danub. 2007 Dec;19(4):342-9.
Evidence based psychiatry and treatment guidelines have a significant role in raising the quality of mental health care and treatment, as well as in providing order where chaos reigns. The purpose of treatment guidelines and algorithms is to provide psychiatrists, health authorities, patients and their families with best evidence for making treatment decisions. However, adherence to some guidelines may do more harm than good if they are not flexible enough to take into account individual patient preferences and circumstances. The paradox at the heart of algorithms-based practice is that gold standard treatments are predicated on statistical generalizations about patients, mental disorders and treatments. In contrast, the effectiveness of a treatment is based on the art and practice of learning organization, the uniqueness of the patient, the doctor-patient relationship and the willingness of the patient to change her/his mental model, life philosophy and the relationships in his family. Treatment guidelines are the lifelines of medical psychiatry and clinical psychopharmacology, without which psychiatry will never reach professional maturity and become fully accepted in medical circles.
循证精神病学和治疗指南在提高精神卫生保健和治疗质量以及在混乱中建立秩序方面发挥着重要作用。治疗指南和算法的目的是为精神科医生、卫生当局、患者及其家属提供做出治疗决策的最佳证据。然而，如果某些指南不够灵活，无法考虑到患者的个人偏好和具体情况，那么遵循这些指南可能弊大于利。基于算法的实践的核心悖论在于，金标准治疗是基于对患者、精神障碍和治疗的统计概括。相比之下，一种治疗方法的有效性基于学习型组织的艺术和实践、患者的独特性、医患关系以及患者改变其思维模式、生活哲学和家庭关系的意愿。治疗指南是医学精神病学和临床精神药理学的生命线，没有它们，精神病学将永远无法达到专业成熟并在医学界被完全接受。
