Maudsley

Debate on latest clinical guidelines for psychosis and schizophrenia in adults

May 12, 2016 1:58 pm Published by

The Clinical Director of The Counselling Foundation, Noel Hargrave attended the triannual Maudsley Debate last night, in order to vote on the latest update for the National Institute for Health and Care Excellence (NICE) guideline “CG178: Psychosis and Schizophrenia in Adults” being unbiased and evidence based.

These guidelines are for health professionals and people with psychosis or schizophrenia, their families and carers. It covers a range of important factors from recognising and preventing psychosis, early intervention, referring, long term care, checks for physical health problems and support for carers.

The update in concern adds to and makes changes to the last guidance published in 2009, and represents a synthesis of available research evidence combined with an economic review of intervention costs.

The process itself was spearheaded by the guideline development group consisting of academic and clinical leaders, allied professionals, health economists, service user and carer representatives.

The new additions to the 2014 guidance included treatment of first episode psychosis, subsequent acute episodes and research recommendations.

The debate was held following a series of exchanges and rebuttals published in the British Journal of Psychiatry (BJPsych) after the publication of the guidelines, and perceived bias in terms of recommended treatment options and the associated research.

The views for it being unbiased and evidence based presented by Professor Sonia Johnson and Professor Steve Pilling were that this was updating and not replacing the 2009 guidance, and that there was no conflict between medication and psychological interventions. They also cited the studies and meta-analysis supporting the guidance,

Against the update being unbiased and evidence based were Dr Mark Taylor and Professor Clive Adams who argued that there were too many recommendations on CBT particularly regarding early intervention in patients at risk of developing schizophrenia. Professor Clive Adams presented an analysis of the guidelines and while positive and well intentioned, was biased towards specific treatment options by stakeholders who had both inevitable institutional and career bias.

Chaired by Professor Sarah Byford, the debate narrowly concluded in favour of the motion that the NICE guideline update concerning psychosis and schizophrenia in adults was indeed unbiased and evidence based. (For 121, against 117 abstentions 31).

Noel commented that “the debate was very well attended by a range of stakeholders, students and interested parties. We look forward to being a part of further discussions and debates.

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