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The diagnosis sections are based on
the ICD-10 classification of mental disorders. ICD-10 is itself
a consensus document, tested for reliability. The ICD-10 diagnostic
criteria presented here have been tested among primary-care
professionals to check for face validity and usefulness. References
supporting evidence have been given in line with the principles
set out below.
The recommendations about medication are all in line
with the British National Formulary (BNF). Where recommendations
about medication are unexceptional and in line with both the
BNF and established practice for many years, references have
not been given. References have been reserved for key statements
about medication and about particular psychotherapies or for
statements about which evidence and opinion are divided. Where
possible, evidence has been given from Cochrane reviews, high
quality published reviews and meta-analyses or randomised
controlled trials (RCTs). Discussions have been held with
experts and authors of key areas of research. The evidence
has been graded as follows:
A = Good evidence to support
B = Fair evidence to support
C = Preliminary evidence to support
I = Evidence obtained from a meta-analysis of trials,
including one or more well-designed RCTs
II = Evidence obtained from one well-designed RCT
III = Evidence obtained from one or more controlled trials,
without randomisation
IV = Evidence obtained from one or more uncontrolled studies
V = Opinions of respected authorities, based on clinical experience,
descriptive studies or reports of expert committees. Occasionally
the 'respected authorities' comprise collective patient experience.
Where this is the case, it is clearly stated.
Where a qualitative review of previously
published literature without a quantitative synthesis of the
data is referenced, it has been graded in accordance with
the type of studies the review includes. Where a reference
is marked 'N', this means that the note contains additional
information or a discussion of the issues, as well as the
reference.
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