Neuro-psychopharmacotherapy and the Differential Diagnostic Approaches in Europe
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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.
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