What are our guidelines?

[Merely]

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It seems most fields have guidelines telling you pretty much exactly what to do and what’s first line for all of the various diseases/disorders. What guidelines should we be learning as interns/residents? Thx

 

[FlowRate]

Most fields have various bodies that put out recommended treatment guidelines. You also see treatment guidelines spun up by state governments, state specialty societies, etc. Just addressing the fact that there's not "one set of guidelines to rule them all" in any field. The guidelines themselves are usually a combination of best available data (lots of lit review) and some amount of professional/personal experience (seen often in UpToDate articles.)

One place you can get started is the Maudsley Prescribing Guidlines in Psychiatry.

 

[clausewitz2]

CANMAT's recent bipolar guidelines are pretty solid and quite educational, getting into evidence base for fourth and fifth-lime treatments.

 

[PikminOC]

It seems most fields have guidelines telling you pretty much exactly what to do and what’s first line for all of the various diseases/disorders. What guidelines should we be learning as interns/residents? Thx

Have you asked your program director? What do they say?

 

[When is graduation again?]

This is a question I've had before too. I think guidelines tend to be most used in primary care settings when there is a clear, researched answer to a problem like which ethnic groups respond best to which anti-hypertensive, metformin in early DM2, or surveillance screening for colonoscopy. With psychiatry, since, technically, many treatments aren't more efficacious than other, people are less inclined to follow guidelines, but instead do their own thing or practice how their programs teach them.

That said, there are actually quite a few guidelines. There are the textbooks of course, but there are also guidelines addressing particular treatment options for particular diagnoses. However, these guidelines are mainly international, focusing in Canada, Europe and Asia. I'm sure there are others in the US, but I don't come across them often when I've searched for this.

For bipolar disorder, for instance, I found the guidelines belowin the citations of an article I read. I try to combine international guidelines with the practices of my residency to find a nice middle ground, since most medical thought differs regionally.
____________________________________________________________

Grunze H, Vieta E, Goodwin G, Bowden C, Licht RW, Moller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: update 2009 on the treatment of bipolar depression. World J Biol Psychiatry. 2010

Nivoli AM, Colom F, Murru A, Pacchiarotti I, Castro-Loli P, González-Pinto A, Fountoulakis KN, Vieta E. New treatment guidelines for acute bipolar depression: a systematic review. J Affect Disord. 2011;129:14–26.

Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O’Donovan C, Macqueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013;15(1):1–44.

Goodwin GM and Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for treating bipolar disorder: revised second edition—recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2009

NICE Clinical Guidelines. Bipolar disorder. The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. National Institute for Health and Clinical Excellence, 2009.

 

[Merely]

Yeah I see Canada has a bunch of guidelines so I’ll go through the CANMAT for anxiety, depression, etc that’s very helpful thx

 

[NickNaylor]

The APA has some guidelines, but the problem is most of them haven't been updated in a very long time. As mentioned, CANMAT puts out great guidelines which are more recent and helpful. There are also some guidelines from the New Zealand/Australian society which are more recent.

 

[MedMan80]

Canmat guidelines for depression, bipolar and anxiety, AACAP practice parameters for child psych, APA guidelines for eating disorders, Texas medication algorithm for some meds, CPA clinical guidelines for schizophrenia, CADDRA guidelines for ADHD, APA and CMAJ guidelines for geriatrics

 

[Merely]

Canmat guidelines for depression, bipolar and anxiety, AACAP practice parameters for child psych, APA guidelines for eating disorders, Texas medication algorithm for some meds, CPA clinical guidelines for schizophrenia, CADDRA guidelines for ADHD, APA and CMAJ guidelines for geriatrics

Tyvm

 

[Coupd'Cat]

I'll throw in "Good Psychiatric Management" guidelines for borderline personality (John Gunderson, Paul Links)