Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
Department of Mental Health and Substance Use, WHO, Geneva, Switzerland.
Schizophr Bull. 2024 Nov 8;50(6):1310-1325. doi: 10.1093/schbul/sbae043.
The World Health Organization's (WHOs) Mental Health Gap Action Programme (mhGAP) aims to improve healthcare for mental, neurological, and substance use disorders in nonspecialized settings, with a focus on low- and middle-income countries (LMICs). mhGAP includes guidelines for the treatment of psychoses (including schizophrenia), which were recently updated in 2023. The complexity of the WHO guideline update process and the updated recommendations on psychoses are presented.
The WHO guideline development process is outlined as well as the evidence appraisal and the translation of the evidence into recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The guideline update process includes a review of the literature, a compilation of systematic reviews, and extracting data related to critical and important outcomes. The updated recommendations and the justifying evidence are discussed.
The WHO mhGAP guidelines for psychoses are adapted to LMICs, and consist of 13 recommendations in 2023, whereof 5 were updated, and 1 recommendation was newly developed. Background information on how these recommendations were obtained, and significant changes since the previous guideline update in 2015 are provided.
Unlike other guidelines, the WHO must consider various countries, contextual factors, and the WHO Model Lists of Essential Medicines when developing its guidelines. A transformation of the WHO guideline for psychoses into a living guideline would ensure always up-to-date recommendations and facilitate shared decision-making.
世界卫生组织（WHO）的心理健康差距行动规划（mhGAP）旨在改善非专业环境中的精神、神经和物质使用障碍的医疗保健，重点是中低收入国家（LMICs）。mhGAP 包括针对精神病（包括精神分裂症）的治疗指南，这些指南最近在 2023 年进行了更新。本文介绍了 WHO 指南更新过程的复杂性以及关于精神病的更新建议。
概述了 WHO 指南制定过程，以及在遵循推荐评估、制定与评价（GRADE）方法学的情况下，对证据进行评估和将证据转化为建议的过程。指南更新过程包括对文献的审查、系统评价的汇编以及提取与关键和重要结局相关的数据。讨论了更新的建议和支持证据。
WHO 精神病 mhGAP 指南适用于 LMICs，2023 年共有 13 项建议，其中 5 项得到更新，1 项新建议。提供了有关如何获得这些建议的背景信息，以及自 2015 年上次指南更新以来的重大变化。
与其他指南不同，WHO 在制定指南时必须考虑到不同的国家、背景因素和 WHO 基本药物示范清单。将 WHO 精神病指南转化为活的指南将确保始终提供最新的建议，并促进共同决策。
