title: Pragmatic randomised controlled trials in psychiatry.
abstract: BACKGROUND
  Randomised controlled trials (RCTs) are the most important method of evaluating new treatments and treatment policies. Despite this, there are relatively few large pragmatic RCTs in psychiatry.
  
  
  OBJECTIVE
  To explore the main advantages of large pragmatic RCTs and the obstacles to performing them in psychiatry.
  
  
  METHODS
  A narrative review of literature on pragmatic RCTs with examples drawn from psychiatry and other medical specialities.
  
  
  RESULTS
  Obstacles to performing pragmatic RCTs in psychiatry include the complexity of psychiatric interventions, the complexity of outcomes used in psychiatry and the difficulties of blinding subjects and investigators to some psychiatric interventions.
  
  
  CONCLUSIONS
  Researchers need to frame questions in a form that is relevant to clinicians and to convince clinicians to cooperate in simple large pragmatic trials.
authors.affiliation: Guy's School of Medicine, London. m.hotopf@iop.bpmf.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Hotopf
authors.forename: R
authors.initials: R
authors.lastname: Churchill
authors.forename: G
authors.initials: G
authors.lastname: Lewis
mesh_terms: D016000:Cluster Analysis; D003365:Costs and Cost Analysis; D004992:Ethics, Medical; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D015588:Observer Variation; D017060:Patient Satisfaction; D018579:Patient Selection; D011379:Prognosis; D011897:Random Allocation; D016032:Randomized Controlled Trials as Topic