CPR for mood disorders: injecting life into clinical practice guidelines


  • Danielle Adams,

    Corresponding author
    1. CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW, Australia
    2. Northern Sydney Central Coast Mental Health Drug and Alcohol Services, NSCCAHS, NSW, Australia
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  • Gin S Malhi

    1. CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW, Australia
    2. Northern Sydney Central Coast Mental Health Drug and Alcohol Services, NSCCAHS, NSW, Australia
    3. Discipline of Psychological Medicine, University of Sydney, NSW, Australia
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Ms Danielle Adams, Department of Psychiatry, CADE Clinic Level 5, Building 36 Royal North Shore Hospital, St Leonards, NSW 2065 Sydney, Australia.
Fax: +61 2 9926 7730
E-mail: dladams@nsccahs.health.nsw.gov.au

Adopting perhaps somewhat literally the mantra of Pictures and Prose, the Mood Matters Project initiated in 2007 by the Northern Sydney Central Coast Mental Health Drug & Alcohol service and CADE Clinic took it upon itself to develop an innovative format that combines diagrams and text so as to make Clinical Practice Guidelines more appealing and easier to assimilate. The product, published in our sister journal, Acta Psychiatrica Scandinavica (1,2), has taken the form of two papers that provide clinical practice recommendations (CPRs) for the treatment of mood disorders specifically, depression and bipolar disorders.

As pointed out in an editorial (3) that accompanies the CPRs most clinical guidelines, though well intentioned and developed to a high standard, ultimately fail to be implemented in clinical practice (4). Therefore, the CPRs have been designed with the ‘busy clinician’ in mind who has little time to wade through and digest the sea of literature that is constantly emerging and the many already existing guidelines that are regularly undergoing change. Instead, the recommendations aim to summarise and structure the evidence-base for treating mood disorders in a succinct and clinically meaningful way. In addition, the recommendations highlight the importance of making treatment decisions not only on the basis of evidence but also after consideration of contextual factors that necessarily vary with each individual.

As an example, Fig. 1 shows some of the diagrams that have been used in the depression and bipolar CPRs. Throughout both sets of recommendations, acronyms have been incorporated to assist memory and capture key messages. Further, by design, the diagrams have made use of colour and employed icons to highlight important aspects of the recommendations and enhance their visual clarity. For example, in the depression CPR the acronym ‘SET A PACE’ is used to provide a template for the recommendations throughout the document and at the same time, the phrase ‘set a pace’ itself acts as a prompt and a reminder to determine the tempo at which the treatments for depression need to be delivered. In essence, this emphasises the need to tailor management according to the individual needs of each patient. By breaking down the acronym further, the importance of ‘SET’-ting the foundations for treatment is emphasised through such measures as ensuring safety and establishing a therapeutic relationship, the key elements to providing a comprehensive ‘A’ssessment are outlined, and the term ‘PACE’ is used to guide treatment selection from a suite of evidence-based interventions ranging from psychological through to pharmacological and physical.

Figure 1.

A sample of some of the diagrams used in the depression and bipolar CPR.

Similarly, the acronym ‘ACT’ (Assessment, Care and Treatment) has been used to provide an overview of the process of managing bipolar disorder. These terms are then used as a platform for structuring subsequent steps in the assessment and treatment of the various phases of bipolar disorder. Throughout theCPR, the importance of continuing care as well as providing evidence-based recommendations via a therapeutic relationship is emphasised.

This unique approach will hopefully make clinical practice ‘guidelines’ more appealing. The rigorous process of multi-disciplinary development has culminated in the development of a set of CPRs that have broad appeal and, while retaining a traditional evidence-based approach, will hopefully increase clinical utility.

Danielle Adams 1,2 Gin S Malhi 1,2,3