Evaluation of evidence grades in psychiatry and psychotherapy guidelines

Background Information regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking. Based on the German evidence- and consensus- based (S3) psychiatry and psychotherapy and the Scottish Intercollegiate Guidelines Network (SIGN) treatment guidelines, we aimed to specify how guideline recommendations are composed and to what extent recommendations are evidence-based. Methods Data was collected from all published evidence- and consensus-based S3-classified psychiatry and psychotherapy guidelines. As control conditions, data from German neurology S3-classified guidelines as well as data from recent SIGN guidelines of mental health were extracted. Two investigators reviewed the selected guidelines independently, extracted and analysed the numbers and levels of recommendations. Results On average, 45.1% of all recommendations are not based on strong scientific evidence in German guidelines of psychiatry and psychotherapy. A related pattern can be confirmed for SIGN guidelines, where the mean average of recommendations with lacking evidence is 33.9%. By contrast, in the German guidelines of neurology the average of such recommendations is 16.5%. A total of 24.5% of all recommendations in the guidelines of psychiatry and psychotherapy are classified as level A recommendations, compared to 31.6% in the field of neurology and 31.1% in the SIGN guidelines. Related patterns were observed for B and 0 level recommendations. Conclusion Guidelines should be practical tools to simplify the decision-making process based on scientific evidence. Up to 45% of all recommendations in the investigated guidelines of psychiatry and psychotherapy are not based on strong scientific evidence. The reasons for this high number remain unclear. Possibly, only a limited number of studies answer clinically relevant questions. Our findings thereby question whether guidelines should include non-evidence-based recommendations to be methodologically stringent and whether specific processes to develop expert-opinion statements must be implemented.

Psychotherapy training experience in the Northern Region Senior Unified SHO Scheme: present and future

Aims and MethodWe conducted this survey to assess the current experience of psychotherapy training in the Northern Deanery and discuss possible effects changes might have on the future of this training. A postal questionnaire assessed the training experienced by the 41 trainees on the Northern Region Senior Unified Senior House Officer (SHO) Psychiatry Training Scheme in 2004. The results were compared with the guidelines from the Royal College of Psychiatrists.ResultsThe response rate was 61%. Particular areas of strength included conducting a long case (64%) and obtaining sufficient teaching in psychodynamic and cognitive–behavioural therapy theory (88%); 92% rated their experience of the training as satisfactory or better, and 68% intended pursuing further training in psychotherapy.Clinical ImplicationsTrainees ought to be familiar with the psychotherapy guidelines from an early point in their training. Specific areas of difficulty within the scheme need to be addressed. Proposed changes to specialist training are likely to have an impact on the psychotherapy training experience.

Implementing psychotherapy guidelines: putting a logbook into practice

The integration of medical/‘biologial’ and psychological approaches to the human mind is unique to psychiatric training. There have been past tensions between the two views, but the ability to integrate them is increasingly recognised as an indispensable contribution of our profession to mental health care as a whole.