Unipolar depressive disorders are among the most frequent reasons for utilizing the health care system. Although efficacious treatments are available and further advances have recently been made there is still a need for improving diagnostic and therapeutic procedures. Alignment of treatment on evidence-based treatment guidelines establishes an essential mainstay. The new S3 and National Health Care guidelines on unipolar depression, the compilation of which was coordinated by the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN) and which were approved by 29 scientific and professional associations, is the ambitious effort to present state of the art evidence and clinical consensus for the treatment of depression. For pharmacotherapy of depression differentiated recommendations can be given, also separate from and in addition to psychotherapy.
Depressive disorders are of high clinical and economic relevance in outpatient and inpatient care. For the treatment of depression effective measures are available. However, these methods often are not used because depressive disorders are underdetected or underestimated in their severity. To improve diagnostic and therapeutic processes in the last years different national and international organizations developed guidelines for diagnosis and treatment of depressive disorders (e. g. AHCPR, APA, German Association of Psychiatrists). These guidelines differ substantially in their goals, content, size, specifically in their methodological quality. The Association of the Scientific Medical Societies in Germany (AWMF) and the German Agency for Quality in Medicine (AQUMED) developed a checklist to evaluate the methodological quality of guidelines. This manual was used to describe and analyze the most relevant and actual six guidelines for diagnosis and treatment of depressive disorders. Recommendations for further improvement and implementation of these guidelines are given.
The majority of patients described by the counselors were dependent drinkers. This indicates that harmful and at risk drinkers are hardly reached by counseling centers. So there is clear space for optimizing the care for people with alcohol-related disorders.
Essential for a successful implementation are sufficient time and personal resources, a motivation for change in staff and centre management, and a positive attitude regarding psycho-diagnostics in clinic staff. Furthermore, flexibility in implementation strategies and the opportunity to participate in the implementation process are important.
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