Keating Dolores, McWilliams Stephen, Schneider Ian, Hynes Caroline, Cousins Gráinne, Strawbridge Judith, Clarke Mary
Pharmacy Department, Saint John of God Hospital, Co Dublin, Ireland.
Saint John of God Hospital, Co Dublin, Ireland.
BMJ Open. 2017 Jan 6;7(1):e013881. doi: 10.1136/bmjopen-2016-013881.
Clinical practice guidelines (CPGs) support the translation of research evidence into clinical practice. Key health questions in CPGs ensure that recommendations will be applicable to the clinical context in which the guideline is used. The objectives of this study were to identify CPGs for the pharmacological treatment of first-episode schizophrenia; assess the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument; and compare recommendations in relation to the key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia.
A multidisciplinary group identified key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia. The MEDLINE and EMBASE databases, websites of professional organisations and international guideline repositories, were searched for CPGs that met the inclusion criteria. The AGREE II instrument was applied by three raters and data were extracted from the guidelines in relation to the key health questions.
In total, 3299 records were screened. 10 guidelines met the inclusion criteria. 3 guidelines scored well across all domains. Recommendations varied in specificity. Side effect concerns, rather than comparative efficacy benefits, were a key consideration in antipsychotic choice. Antipsychotic medication is recommended for maintenance of remission following a first episode of schizophrenia but there is a paucity of evidence to guide duration of treatment. Clozapine is universally regarded as the medication of choice for treatment resistance. There is less evidence to guide care for those who do not respond to clozapine.
An individual's experience of using antipsychotic medication for the initial treatment of first-episode schizophrenia may have implications for future engagement, adherence and outcome. While guidelines of good quality exist to assist in medicines optimisation, the evidence base required to answer key health questions relevant to the pharmacological treatment of first-episode schizophrenia is limited.
临床实践指南（CPG）有助于将研究证据转化为临床实践。CPG中的关键健康问题确保了指南中的建议适用于使用该指南的临床环境。本研究的目的是确定首次发作精神分裂症药物治疗的CPG；使用《研究与评价指南评估II》（AGREE II）工具评估这些指南的质量；并比较与首次发作精神分裂症药物治疗相关的关键健康问题的建议。
一个多学科小组确定了与首次发作精神分裂症药物治疗相关的关键健康问题。检索MEDLINE和EMBASE数据库、专业组织网站和国际指南库，以查找符合纳入标准的CPG。由三名评估者应用AGREE II工具，并从指南中提取与关键健康问题相关的数据。
共筛选了3299条记录。10项指南符合纳入标准。3项指南在所有领域得分都很高。建议的具体程度各不相同。在选择抗精神病药物时，关键考虑因素是副作用问题，而非疗效比较优势。建议使用抗精神病药物维持首次发作精神分裂症后的缓解状态，但缺乏指导治疗持续时间的证据。氯氮平被普遍视为治疗抵抗的首选药物。对于对氯氮平无反应者，指导护理的证据较少。
个人使用抗精神病药物初始治疗首次发作精神分裂症的经历可能会对未来的参与度、依从性和结局产生影响。虽然存在高质量的指南来协助优化用药，但回答与首次发作精神分裂症药物治疗相关的关键健康问题所需的证据基础有限。
