Use or underuse of therapeutic guidelines in psychiatry?

A rapid expansion of new treatment options in recent decades and the increasing volume of scientific evidence published on a daily basis have been followed by the necessity of introduction of clinical guidelines and therapeutic algorithms. The development of these guidelines and algorithms has also been driven by increased cost-awareness and the increasing pressure to improve cost-efficiency. The Serbian Physicians Society published "Therapeutic Guidelines for the Treatment of Schizophrenia" in 2003 and "Therapeutic Guidelines for the Treatment of Bipolar Affective Disorder" in 2004. The School of Medicine, University of Belgrade published "Therapeutic Guidelines for the Treatment of Depression" in 2004. All of these national guidelines, at the moment of development, were based upon up-to-date scientific evidence. According to the recently conducted survey at the Institute of Psychiatry, Clinical Centre of Serbia, about 65% of psychiatrists stated that they adhere to the national or relevant international therapeutic guidelines. When asked to cite which international or foreign guidelines in particular they used, approximately 50% failed to do so, while the other half cited mostly the APA Guidelines or NICE Guidelines. Among the national guidelines, physicians are, according to the survey, familiar with the Therapeutic Guidelines for the treatment of Schizophrenia (46.3%), Therapeutic Guidelines of Depression (41.5%) and Therapeutic Guidelines for the Treatment of Bipolar Affective Disorder (34.1%). The majority of Serbian psychiatrists rely on the efficacy and safety of the drugs as the major determining factors in the choice of therapy, bearing in mind the patients' best interests. However, it is unclear why such a discrepancy between practice and guidelines still persists, since guidelines also recommend therapy based on their safety and efficacy data. It is possible that a substantial percentage of psychiatrists obtain indicators on drugs' efficacy and safety from their personal professional experience. It is doubtful whether this knowledge is valid, or just represents unproven prescribers' habits. Furthermore, the influence on other factors, such as treatment costs or drug availability should be further investigated.