Letter to Editor Evaluation of Clinical Guidelines in Psychiatry Sir, As we are already aware, there are a plethora of clinical practice guidelines available for a clinical psychiatrist today. Some of the popular ones include those published by American Psychiatric Society, National Institute of Clinical Excellence, Canadian Network for Mood and Anxiety Treatments, Texas Medical Algorithm Project and Indian Psychiatric Society in our country. A psychiatric clinician is usually bewildered by the choices in front of him, which would be the best choice among the options available? This is the reason why research on the superiority of one set of guidelines over another becomes imperative. One also needs to be aware of existence of appraisal tools for clinical practice guidelines, which can discern the best from the entire lot. Some common appraisal tools available include Cluzeau instrument, AGREE instrument based on the Cluzeau instrument. [1] Some of the common dimensions considered for evaluation of clinical guidelines are scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, methodological rigour of development, context, content, application and editorial independence. Of all these dimensions, methodological rigour or quality appears to be the single most important factor that decides the quality of clinical care guidelines. A recent systematic review of these appraisal tools mentions Cluzeau as the only tool that has been well-validated and well-accepted.[1] There are only a few studies that use these appraisal tools to compare various clinical guidelines in psychiatr y. These include a British study on depressive guidelines and a study on guidelines for schizophrenia.[2,3] Such studies give invaluable

information with regard to the quality of various clinical guidelines available. We cannot afford to ignore this area of research in clinical psychiatry any longer with the advent of evidence-based medicine and proliferation of clinical guidelines with various psychiatric societies coming out with their own guidelines.

Sundar Gnanavel Department of Psychiatry, AIIMS, New Delhi, India Address for correspondence: Dr. Sundar Gnanavel, Department of Psychiatry, AIIMS, Ansari Nagar, New Delhi - 110 029, India. E-mail: [email protected]

REFERENCES 1.

2.

3.

Vlayen J, Aertgeerts B, Hannes K, Sermeus W, Ramaekers D. A systematic review of appraisal tools for clinical practice guidelines: Multiple similarities and one common deficit. Int J Qual Health Care 2005;17:235-42. Littlejohns P, Cluzeau F, Bale R, Grimshaw J, Feder G, Moran S. The quantity and quality of clinical practice guidelines for the management of depression in primary care in the UK. Br J Gen Pract 1999;49:205-10. Gaebel W, Weinmann S, Sartorius N, Rutz W, McIntyre JS. Schizophrenia practice guidelines: International survey and comparison. Br J Psychiatry 2005;187:248-55. Access this article online Quick Response Code

Website: www.ijpm.info

DOI: 10.4103/0253-7176.135400

Lomotil Dependence Sir, The recent report on “Lomotil dependence.”[1] Mehra

et al. concluded that “regulatory controls are needed to prevent escalation of use of this easily available prescription opioid.”[1] In fact, lomotil can be bought

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Indian Journal of Psychological Medicine | Jul - Sep 2014 | Vol 36 | Issue 3

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