title: Making the use of psychotropic drugs more rational through the development of GRADE recommendations in specialist mental healthcare.
abstract: BACKGROUND
  In recent years the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology has often been used by international or national health authorities, or scientific societies, for developing evidence-based treatment recommendations. However, the GRADE approach has never been used by practicing physicians who aim at harmonizing their prescribing behaviours paying due attention to the best available evidence. This paper describes the experience of a working group of psychiatrists who adopted the GRADE approach to develop clinical recommendations on the use of psychotropic drugs in specialist mental healthcare.
  
  
  METHODS
  The project was conducted in the Department of Mental Health of Verona, Italy, a city located in the north of Italy. At the beginning of 2012, psychiatrists with a specific interest in the rational use of psychotropic drugs were identified and appointed as members of a Guideline Development Group (GDG). The first task of the GDG was the identification of controversial areas in the use of psychotropic drugs, the definition of scoping questions, and the identification of outcomes of interest. The GDG was supported by a scientific secretariat, who searched the evidence, identified one or more systematic reviews matching the scoping questions, and drafted GRADE tables.
  
  
  RESULTS
  On the basis of efficacy, acceptability, tolerability and safety data, considering the risk of bias and confidence in estimates, and taking also into consideration preferences, values and practical aspects in favour and against the intervention under scrutiny, a draft recommendation with its strength was formulated and agreed by GDG members. Recommendations were submitted for consideration to all specialists of the Department, discussed in two plenary sessions open to the whole staff, and finally approved at the end of 2012.
  
  
  CONCLUSIONS
  The present project of guideline development raised several challenging and innovating aspects, including a "bottom-up" approach, as it was motivated by reasons that found agreement among specialists, those who developed the recommendations were those who were supposed to follow them, and values, preferences and feasibility issues were considered paying due attention to local context variables.
authors: WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Verona, Italy. corrado.barbui@univr.it.
authors: Giovanni
authors: G
authors: Ostuzzi
authors: Irene
authors: I
authors: Bighelli
authors: Barbara-Vanessa
authors: BV
authors: Carrara
authors: Nicola
authors: N
authors: Dusi
authors: Giuseppe
authors: G
authors: Imperadore
authors: Camilla
authors: C
authors: Lintas
authors: Francesco
authors: F
authors: Nifosì
authors: Michela
authors: M
authors: Nosè
authors: Carlo
authors: C
authors: Piazza
authors: Marianna
authors: M
authors: Purgato
authors: Raffaella
authors: R
authors: Rizzo
authors: Corrado
authors: C
authors: Barbui
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