Magellan Re-Adopts Three Clinical Practice Guidelines
Magellan offers network providers relevant clinical practice guidelines to assist you in delivering quality care. In January 2010, we re-adopted and approved updates of three clinical practice guidelines to serve as the evidence-based framework for practitioners’ clinical decision-making for the treatment of patients with the following conditions:
- Schizophrenia
- Acute Stress and Posttraumatic Stress Disorders
- Major Depressive Disorder.
Schizophrenia
Magellan re-adopted the American Psychiatric Association’s (APA) Practice Guideline for the Treatment of Patients with Schizophrenia, Second Edition (February 2004) and the Guideline Watch (September 2009): Practice Guideline for the Treatment of Patients with Schizophrenia.
Magellan revised our Introduction to the adopted guideline to include updated references throughout, based on a literature search through August 2009. Additional information included from current studies and key points found in the APA guidelines:
- New section on epidemiology reflects current research findings on the co-aggregation of schizophrenia and bipolar disorder in families.
- First Episode/Early Psychosis section contains a summary of findings from three new studies.
- First Generation vs. Second Generation Agents section now includes key points from recent literature and the APA Guideline Watch.
- Metabolic Disturbances section contains new information about managing weight gain and metabolic disturbances.
- Schizophrenia in Children and Adolescents section includes findings from current studies to add an evidence basis for clinical decision-making in treating children and adolescents.
- New Cognitive Remediation and Rehabilitation section summarizes APA discussion on this intervention.
Acute Stress Disorders (ASD) – Posttraumatic Stress Disorder (PTSD)
Also, Magellan re-adopted the American Psychiatric Association’s (APA) Clinical Practice Guideline for the Assessment Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder (2004) and Clinical Practice Guideline for the Assessment Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder: A Quick Reference Guide. The APA Guideline Watch provides additional information that has become available since publication of the guideline.
Key elements found in Magellan’s Introduction to the Guideline:
ASD
- The Guideline Watch reports that while early intervention studies for ASD are currently in progress, no major research on the treatment of ASD has been completed since publication of the 2004 Guideline.
- The factors predicting the development of ASD or PTSD still have not been established; research results found that ASD was a poorer predictor of getting PTSD than just having PTSD criteria alone in the acute stage.
PTSD
- Research published since 2004 supports exposure-based cognitive-behavioral therapies such as cognitive processing therapy and prolonged exposure therapy as effective treatments for PTSD when delivered in individual formats.
- Virtual Reality Exposure Therapy shows promise in the treatment of disaster workers with PTSD but larger randomized controlled trials are needed.
- More recent research suggests that selective serotonin reuptake inhibitors SSRIs may no longer be recommended with the same level of confidence for veterans with combat-related PTSD as for patients with non-combat related PTSD. The APA Guideline Watch (March 2009) notes that further research is needed.
Major Depressive Disorders
Finally, Magellan revised the Introduction and re-adopted the APA Practice Guideline for the Treatment of Patients With Major Depressive Disorder Second Edition and the 2005 update of that document entitled Guideline Watch: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd Edition.
Some of the key changes to Magellan’s Introduction to the Guideline:
- Added references to Effexor and Pristiq to the section on new drugs
- Added FDA approval information on Abilify as an augmenting agent to antidepressants
- Added information from the American Congress of Obstetricians and Gynecologists (ACOG) and APA on fetal and neonatal outcomes associated with depression and antidepressant treatment during childbearing
- Significantly expanded the section on women and depression
- Updated the section on neurostimulation therapies (ECT, rTMS, MST and VNS)
- Clarified antidepressant doses and further explained length of the maintenance phase.
Use of Guidelines
We encourage you to be familiar with the Magellan Introductions, as well as the information in all guidelines.
All Magellan-adopted clinical practice guidelines are intended to augment, not replace, your sound clinical judgment. However, when you decide to provide care that does not adhere to a Magellan-adopted guideline, please be sure that the clinical record reflects that you weighed the recommendations in the guideline against the member’s clinical status and needs, and planned a clinically appropriate course of action.
Obtaining Copies of the Guidelines
Visit the Clinical Practice Guideline page of this provider website for information on how to obtain copies of guidelines.
Provider Feedback
We welcome your input on our adopted clinical practice guidelines. We will take all suggestions and recommendations into consideration in our next review. Submit comments to your local Magellan provider advisory group or local Magellan medical director, or e-mail comments to Kathleen Frampton at KKFrampton@MagellanHealth.com.