{"id":23913,"date":"2026-04-14T19:05:48","date_gmt":"2026-04-14T17:05:48","guid":{"rendered":"https:\/\/sygeplejevidenskab.dk\/?p=23913"},"modified":"2026-04-14T19:05:48","modified_gmt":"2026-04-14T17:05:48","slug":"evidensniveauet-bag-psykiatriens-kliniske-vejledninger-er-lavt-kun-en-broekdel-er-baseret-paa-hoejeste-grad-af-evidens","status":"publish","type":"post","link":"https:\/\/sygeplejevidenskab.dk\/index.php\/2026\/04\/14\/evidensniveauet-bag-psykiatriens-kliniske-vejledninger-er-lavt-kun-en-broekdel-er-baseret-paa-hoejeste-grad-af-evidens\/","title":{"rendered":"Evidensniveauet bag psykiatriens kliniske vejledninger er lavt: kun en br\u00f8kdel er baseret p\u00e5 h\u00f8jeste grad af evidens"},"content":{"rendered":"

\"\"<\/p>\n

R\u00f8mer TB, Biskin RS, Benros ME, et al. Levels of evidence supporting American, European and international guidelines in psychiatry, 2014\u20132024: a systematic review with quantitative synthesis. BMJ Mental Health. 2026;26(1). DOI: <\/span>10.1136\/bmjment-2025-302194<\/a><\/p>\n

Maj Siercke, sygeplejerske, ph.d., chefredakt\u00f8r, stifter af Sygeplejevidenskab.dk<\/em>. <\/span>maj@sygeplejevidenskab.dk<\/span><\/a><\/p>\n

Download Resume som pdf<\/a><\/p>\n

Resum\u00e9
\n<\/span>Introduktion
\n<\/span><\/strong>Internationale kliniske retningslinjer er et centralt fundament for diagnostik og behandling i psykiatrien, men det er uklart, hvor stor en del af anbefalingerne der reelt hviler p\u00e5 st\u00e6rk forskningsbaseret evidens. Forfatterne bag studiet har derfor kortlagt evidensniveauet bag anbefalingerne i de st\u00f8rste amerikanske, europ\u00e6iske og internationale psykiatriske retningslinjer udgivet fra 2014 til 2024.<\/span><\/p>\n

Metode
\n<\/span><\/strong>Studiet er et systematisk review af 24 internationale retningslinjer fra bl.a. APA (American Psychiatric Association), EPA (European Psychiatric Association), WFSBP (World Federation of Societies of Biological Psychiatry) og WHO (World Health Organization) med i alt 545 behandlingsanbefalinger. For hver anbefaling blev b\u00e5de guideline-forfatternes egen evidensvurdering og de underliggende studietyper vurderet og standardiseret i forhold til GRADE-skalaen. GRADE st\u00e5r for <\/span>Grading of Recommendations Assessment, Development and Evaluation <\/span>og er et internationalt system til at vurdere hvor solid den samlede evidens er, og hvor st\u00e6rke de kliniske anbefalinger er. GRADE klassificerer evidens i fire niveauer: h\u00f8j, moderat, lav og meget lav, afh\u00e6ngigt af bl.a. studiedesign, risiko for bias, konsistens og pr\u00e6cision.<\/span><\/p>\n

Resultater
\n<\/span><\/strong>Kun 63 ud af 545 anbefalinger (11,6 %) er vurderet som baseret p\u00e5 h\u00f8j evidens, 30,3 % er baseret p\u00e5 moderat evidens, mens 34,7 %. bygger p\u00e5 meget lav evidens. For de st\u00e6rkeste anbefalinger er 17,7 %. alene underst\u00f8ttet af ekspertvurderinger eller kasuistikker (enkeltst\u00e5ende cases) uden randomiserede fors\u00f8g. Evidensniveauet varierede betydeligt p\u00e5 tv\u00e6rs af organisationer og emner; EPA l\u00e5 h\u00f8jest med ca. 20 pct. anbefalinger baseret p\u00e5 h\u00f8j evidens. For de farmakologiske behandlinger var 14,6 % af anbefalingerne baseret p\u00e5 h\u00f8j evidens, med 41 ud af 281 anbefalinger.<\/span><\/p>\n

I den modsatte ende finder man anbefalinger om organisering af behandling og somatisk vurdering af patienter med sv\u00e6r psykisk sygdom. Her er henholdsvis 2,2 % og 0 % af anbefalingerne baseret p\u00e5 h\u00f8jt evidensniveau. ADHD, autisme og selvmordsforbyggelse udg\u00f8r mindre end 10 af de unders\u00f8gte anbefalinger, idet studier, der ikke er blevet opdateret inden for de sidste 10 \u00e5r, blev ekskluderet (35 %).<\/span><\/p>\n

Diskussion og konklusion
\n<\/span><\/strong>Resultaterne viser, at hovedparten af anbefalingerne i store psykiatriske retningslinjer ikke er baseret p\u00e5 den bedste tilg\u00e6ngelige evidens, selvom mange anbefalinger faktisk citerer randomiserede fors\u00f8g. Evidensen nedgraderes ofte pga. metodiske begr\u00e6nsninger, sm\u00e5 studier og utilstr\u00e6kkelig blinding, og flere klinisk vigtige omr\u00e5der som ADHD, autisme og selvmordsforebyggelse er svagt d\u00e6kket og ofte med uaktuelle retningslinjer.<\/span><\/p>\n

Implikationer for praksis
\n<\/span><\/strong>For klinikere understreger studiet behovet for kritisk brug af retningslinjer og tydelig dialog med patienter om usikkerhed i evidensgrundlaget. Forfatterne anbefaler, at sundhedsv\u00e6senet prioriterer og finansierer robuste, praksisn\u00e6re fors\u00f8g og mere systematisk opdatering af psykiatriske retningslinjer, s\u00e5 centrale indsatser i h\u00f8jere grad hviler p\u00e5 solid evidens.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

R\u00f8mer TB, Biskin RS, Benros ME, et al. Levels of evidence supporting American, European and international guidelines in psychiatry, 2014\u20132024: 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