Royal Australian and New Zealand College of Psychiatrists (RANZCP) Guidelines on Schizophrenia – A Synopsis by Prof Castle

Posted on February 25, 2019
Time to read: 14–17 minutes

The recent publication of the RANZCP Guidelines for the Treatment of Schizophrenia and Related Disorders (henceforward ‘the guidelines’) affords an opportunity to reflect on our clinical practice and see how well our usual care of people with schizophrenia maps against the guidelines. [1]

The guidelines themselves are just that: guidelines. I tend to think that if around 80% of what we do clinically is guideline-compatible, then we are about hitting the mark: it leaves the 20% to clinical nous, exceptional clinical scenarios, and the art of psychiatry.

But if we are outside the guidelines more that 80%, I would argue that either the guidelines are rubbish, or our practice is out of step with mainstream thinking.

One of the reasons I like the RANZCP guidelines is that they are not simply a distillate of randomised controlled trials and meta-analytic studies, but rather take those sources and blend them with clinical insight, bedded into the local ANZ clinical context.

Here a declaration of conflict of interest is appropriate, as I was a member of the writing group. This allowed me to observe and participate in a process which was rather informative regarding ‘how things happen’.

Numerous teleconferences and emails and draft after draft after draft, before various rounds of commentary further shaped them. Are they perfect? Surely not. But are they a reasonable reflection of what could be considered good contemporary practice? Yes indeed, in my view at least.

The guidelines have been published in full [1] and in a summarised form [2]. In this article I merely skim the surface, delving a bit deeper in certain selected topics.

I have also brought my perspective to the discussion, showing my particular proclivities and biases. Thus, the opinions expressed here are mine and are certainly not definitive.

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