Faculty Bibliography

BACKGROUND: Schizophrenia guidelines differ considerably in methodology and content. AIMS: To systematically compare national schizophrenia guidelines from different countries. METHOD: An international survey was conducted on guideline development and a methodological comparison was made using a validated guideline appraisal instrument (the Appraisal Guideline Research and Evaluation Europe). RESULTS: The methodological quality of many schizophrenia guidelines was at best moderate. Few guidelines had included key stakeholders in their development process. Although pharmacotherapy recommendations were similar, there were strong variations in the type of psychosocial interventions recommended. CONCLUSIONS: The methodological quality of guidelines has a strong influence on their applicability. However, the lack of financial means to develop and implement guidelines is a serious problem. Independent international organisations could contribute to defining a core set of unbiased schizophrenia treatment recommendations. In countries with a shortage of resources, this could be a basis for adaptation to different cultural and economic backgrounds in collaboration with stakeholders

BACKGROUND: There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. AIMS: To improve understanding of prior care-seeking and treatment of new patients seen at mental health services. METHOD: Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. RESULTS: The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as 'gatekeeper' in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. CONCLUSIONS: Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care