What is to become of the College clinical practice guidelines?

When should psychotherapy be the treatment of choice for major depressive disorder?

Clinicians should think carefully before deciding on the initial treatment for a patient with major depressive disorder. The author argues that this does not happen often enough, and that psychotherapy may be overlooked too often as a first treatment option. Based on the research literature and the American Psychiatric Association Practice Guidelines, this article reviews potential cautions and relative indications for initiating treatment with evidence-based psychotherapies for major depressive disorder. Potential indications include 1) patient preference; 2) symptom severity; 3) relative contraindications to pharmacotherapy; 4) prior treatment history; 5) nature of symptoms; 6) psychosocial context, including a life crisis or complicated bereavement; 7) control and credit; and 8) new and enduring skills.

Dissemination and implementation of the Royal Australian and New Zealand College of Psychiatrists' clinical practice guidelines

OBJECTIVE

The aim of this paper is to summarize information about the dissemination and implementation of the Royal Australian and New Zealand College of Psychiatrists' clinical practice guidelines (CPGs) since their completion in 2003, and assess the effectiveness of these activities.

METHOD

The dissemination and implementation activities undertaken from 2003 to the present are described. Data regarding the dissemination of the clinician and consumer-carer versions of the CPGs are presented. The results of a series of implementation pilots are summarized.

RESULTS

Available data suggest the CPGs have been widely disseminated through both the clinician and consumer-carer communities in Australia and New Zealand, and that the consumer-carer versions in particular continue to be in high demand. Evaluation of CPG implementation pilots, using tools that assist in bringing summary evidence into clinical practice, have suggested that such tools are acceptable, are a useful aid to implementing evidence-based practice, and have a positive impact on practice. Common barriers to implementing the evidence are highlighted.

CONCLUSIONS

Summary consumer-carer versions of CPGs seem to be acceptable and useful to both consumer-carers and non-government mental health providers. Locally led implementation of CPGs using tools that summarize evidence and support its use in everyday practice has a positive impact, but also highlights system-level barriers to implementing evidence-based practice.