Neuro-psychopharmacotherapy and the Differential Diagnostic Approaches in Europe
At present there are no Pan-European guidelines regarding the differential diagnostic approach for most psychiatric diseases. Exceptions are guidelines for the diagnosis of Tourette syndrome or Alzheimer’s disease published by European societies. By contrast, national guidelines give recommendations on how to approach the patient with initial or recurrent presentation of, e.g., psychotic symptoms, which diagnostic measures to take or which kind of first-line treatment to choose for common clinical scenarios.
In this chapter we focus on the differential diagnostic approach to the patient with psychotic symptoms and have chosen the guidelines of the World Federation of Societies for Biological Psychiatry for schizophrenia as a reference and compared these to six national guidelines available in German or English. Tables summarize commonalities and disparities on how to establish a diagnosis, of neuro-psychopharmacotherapeutical recommendations according to different treatment phases or treatment resistance, and on how to approach different kinds of symptomatology, subtypes, and specific clinical situations.
We found that the six national guidelines each focus on different aspects of schizophrenia in particular. While recommendations for the initial approach were found to be most consistent, details of diagnostic measures differed as well as suggestions on how to deal with certain clinical situations or comorbidities. Although we only focused on the differential diagnostic approach for schizophrenia, we hope that our elaboration may serve as a model for a differential diagnostic approach for other psychiatric diseases as well.
- Catalan Agency for Health Technology Assessment and Research. Clinical practice guideline for schizophrenia and incipient psychotic disorder. Clinical Practice Guidelines in the NHS [Internet]. Barcelona; 2009.Google Scholar
- Degryse J, De Lepeleire J, Southgate L, Vernooij-Dassen M, Gay B, Heyrman J. An evaluation of a computer based education program for the diagnosis and management of dementia in primary care. An international study of the transcultural adaptations necessary for European dissemination. Med Teach. 2009;31(5):397–402.CrossRefGoogle Scholar
- DGPPN e.V., editor. für die Leitliniengruppe. S3-Leitlinie Schizophrenie. Langfassung. AWMF-Register Nr 038-009. 2019 (Version 1.0).Google Scholar
- European Psychiatric Association. 2018. https://www.europsy.net/publications/guidance-papers/
- Kasper S, Sachs GM, Bach M, Erfurth A, Frey R, Fruhwürth G, Geretsegger C, Gößler R, Hofer A, Jagsch C, Kapfhammer H-P, Kienbacher C, Klier C, Lehofer M, Marksteiner J, Miller-Reiter E, Psota G, Rados C, Rainer M, Willeit M, Windhager E. Schizophrenie Medikamentöse Therapie. Konsensus-Statement – State of the art 2016. CliniCum neuropsy. 2016; Sonderausgabe November.Google Scholar
- National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: treatment and management: updated edition 2014. London: National Institute for Health and Clinical Excellence Guidance; 2014.Google Scholar
- Scottish Intercollegiate Guidelines Network (SIGN). Management of schizophrenia. SIGN publication no. 131. Edinburgh; 2013. http://www.sign.ac.uk