Hasan A, Wobrock T, Gaebel W, Janssen B, Zielasek J, Falkai P
Nervenarzt. 2013 Nov;84(11):1359-60, 1362-4, 1366-8. doi: 10.1007/s00115-013-3913-6.
Treatment guidelines provide evidence-based recommendations for diagnosis and treatment to assist clinicians, care givers and patients in finding an optimized treatment option in given clinical situations. Specific treatment guidelines for schizophrenia issued by the German Association of Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and published under the auspices of the Working Group for Scientific Medical Specialist Societies (AWMF) (i.e. fulfilling the highest quality standards at the S3 level) have been available in Germany since 2006. Currently, a comprehensive revision process is ongoing to update these guidelines with the aim to publish the revision before 2014. However, since publication of the German treatment guidelines many clinical trials and meta-analyses have been published which appear to make a new evaluation of antipsychotic drug treatment necessary. Currently available national and international guidelines, such as the WFSBP, PORT and NICE guidelines, place less emphasis on the general superiority of atypical antipsychotic medication but support the idea to evaluate antipsychotic drugs based on the side effect profiles. The present overview discusses the recent guidelines development processes regarding schizophrenia and compares the available German treatment guidelines with recently published international guidelines. Current developments and issues for discussion are described in detail to provide possible implications for changes in treatment recommendations.
治疗指南提供基于证据的诊断和治疗建议,以帮助临床医生、护理人员和患者在特定临床情况下找到优化的治疗方案。德国精神科、心理治疗与身心医学协会(DGPPN)发布并在科学医学专业协会工作组(AWMF)主持下出版的精神分裂症特定治疗指南(即达到S3级别的最高质量标准)自2006年起在德国可用。目前,正在进行全面修订过程以更新这些指南,目标是在2014年前发布修订版。然而,自德国治疗指南发布以来,已发表了许多临床试验和荟萃分析,这似乎有必要对抗精神病药物治疗进行新的评估。目前可用的国家和国际指南,如世界生物精神病学协会联盟(WFSBP)、美国精神病学协会实践指南(PORT)和英国国家卫生与临床优化研究所(NICE)指南,较少强调非典型抗精神病药物的总体优越性,但支持基于副作用概况评估抗精神病药物的观点。本综述讨论了近期精神分裂症指南的制定过程,并将现有的德国治疗指南与最近发布的国际指南进行了比较。详细描述了当前的发展情况和讨论的问题,以提供治疗建议变化可能产生的影响。