Treatment of adult patients with schizophrenia and complex mental health needs - A national clinical guideline.
OBJECTIVE
The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key issues.


METHODS
Systematic literature searches were performed stepwise for each review question to identify relevant guidelines, systematic reviews/meta-analyses, and randomized controlled trials. The quality of the body of evidence for each review question was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Clinical recommendations were developed on the basis of the evidence, assessment of the risk-benefit ratio, and perceived patient preferences.


RESULTS
Based on the identified evidence, a guideline development group (GDG) recommended that the following interventions should be offered routinely: antipsychotic maintenance therapy, family intervention and assertive community treatment. The following interventions should be considered: long-acting injectable antipsychotics, neurocognitive training, social cognitive training, cognitive behavioural therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence was available, the GDG agreed on a good practice recommendation.


CONCLUSIONS
The implementation of this guideline in daily clinical practice can facilitate good treatment outcomes within the population of patients with schizophrenia and complex mental health needs. The guideline does not cover all available interventions and should be used in conjunction with other relevant guidelines.
a Danish Health and Medicines Authority and Mental Health Centre Glostrup , Denmark .
Lone
L
Baandrup
b Danish Health and Medicines Authority , Denmark .
Jesper
J
Østrup Rasmussen
c Danish Health and Medicines Authority and the Parker Institute, Bispebjerg and Frederiksberg Hospital , Denmark .
Louise
L
Klokker
d Mental Health Centre Nordsjælland , Denmark .
Stephen
S
Austin
e General Practice , Aars , Denmark .
Thomas
T
Bjørnshave
f Aarhus University Hospital , Risskov , Denmark .
Vibeke
V
Fuglsang Bliksted
g Mental Health Centre Copenhagen , Denmark .
Anders
A
Fink-Jensen
h Frederiksbergpsykologen , Frederiksberg , Denmark .
Allan
A
Hedegaard Fohlmann
i Mental Health Services, Region of Southern Denmark and Institute of Regional Health Research, University of Southern Denmark , Odense , Denmark .
Jens
J
Peter Hansen
j Danish Health and Medicines Authority , Copenhagen , Denmark .
Malene
M
Kristine Nielsen
k Mental Health Centre Hvidovre , Denmark , and.
Karl Erik
KE
Sandsten
g Mental Health Centre Copenhagen , Denmark .
Vilhelm
V
Schultz
g Mental Health Centre Copenhagen , Denmark .
Susanne
S
Voss-Knude
l Danish Health and Medicines Authority, Mental Health Centre Copenhagen and Institute of Clinical Medicine, Faculty of Health Science, University of Copenhagen , Denmark.
Merete
M
Nordentoft
D014150:Antipsychotic Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003718:Denmark; D017831:Diagnosis, Dual (Psychiatry); D019317:Evidence-Based Medicine / Q000379:methods; D005196:Family Therapy / Q000379:methods; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D012559:Schizophrenia / Q000628:therapy*; D019966:Substance-Related Disorders / Q000628:therapy; D016896:Treatment Outcome
D014150:Antipsychotic Agents
Clinical guideline; GRADE; meta-analysis; quality of evidence; schizophrenia; strength of recommendations