Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review
Abstract Objective It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review was to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance abuse in r...
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | BMC Psychiatry |
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| Online Access: | https://doi.org/10.1186/s12888-021-03188-0 |
| _version_ | 1818676253791617024 |
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| author | Ray Alsuhaibani Douglas Cary Smith Richard Lowrie Sumayah Aljhani Vibhu Paudyal |
| author_facet | Ray Alsuhaibani Douglas Cary Smith Richard Lowrie Sumayah Aljhani Vibhu Paudyal |
| author_sort | Ray Alsuhaibani |
| collection | DOAJ |
| description | Abstract Objective It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review was to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance abuse in relation to diagnosis and treatment of co-existing disorders and considerations for wider social and contextual factors in treatment recommendations. Method A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on ‘Appraisal of Guidelines for Research & Evaluation II’ (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline. Result A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnosis such as homelessness and safeguarding and associated referral pathways were sparsely mentioned. Conclusion Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care. |
| first_indexed | 2024-12-17T08:40:33Z |
| format | Article |
| id | doaj.art-f738534f6d77492997e82bf4ab89b413 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-17T08:40:33Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-f738534f6d77492997e82bf4ab89b4132022-12-21T21:56:21ZengBMCBMC Psychiatry1471-244X2021-04-0121112310.1186/s12888-021-03188-0Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic reviewRay Alsuhaibani0Douglas Cary Smith1Richard Lowrie2Sumayah Aljhani3Vibhu Paudyal4School of Biosciences, University of Birmingham, EdgbastonSchool of Social Work, University of Illinois at Urbana-ChampaignHomeless Health, Pharmacy Services, NHS Greater Glasgow and ClydeDepartment of Psychiatry, College of medicine, Qassim UniversitySchool of Pharmacy, College of Medical and Dental Sciences, University of BirminghamAbstract Objective It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review was to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance abuse in relation to diagnosis and treatment of co-existing disorders and considerations for wider social and contextual factors in treatment recommendations. Method A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on ‘Appraisal of Guidelines for Research & Evaluation II’ (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline. Result A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnosis such as homelessness and safeguarding and associated referral pathways were sparsely mentioned. Conclusion Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care.https://doi.org/10.1186/s12888-021-03188-0Severe mental illnessSubstance use disordersSubstance misuseSubstance abuseCoexisting disordersDual diagnosis |
| spellingShingle | Ray Alsuhaibani Douglas Cary Smith Richard Lowrie Sumayah Aljhani Vibhu Paudyal Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review BMC Psychiatry Severe mental illness Substance use disorders Substance misuse Substance abuse Coexisting disorders Dual diagnosis |
| title | Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review |
| title_full | Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review |
| title_fullStr | Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review |
| title_full_unstemmed | Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review |
| title_short | Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review |
| title_sort | scope quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis social and community outcomes a systematic review |
| topic | Severe mental illness Substance use disorders Substance misuse Substance abuse Coexisting disorders Dual diagnosis |
| url | https://doi.org/10.1186/s12888-021-03188-0 |
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