ANZJP this month: AAA-llelujah!

As you relax in your armchair reflecting on another year ‘over’ and wondering with some degree of trepidation what the New Year – or indeed Santa – might bring, you can rest assured that the ANZJP will ‘deliver’. If taken as prescribed, this issue of the ANZJP will provide ample grey matter stimulation that may even uplift your spirits. This month we have an abundance of ‘A’s: the Anxiety clinical practice guidelines (CPGs), AREDOC and the Ashes.

More than half of this particular festive issue is devoted to the latest instalment of the College guidelines. Having been entrusted with one of these projects some years ago myself, I know full well what Andrews et al. (this issue) have had to sacrifice in order to achieve this feat. The anxiety CPGs are well worth reading, or at least sampling from time to time, but then, as Editor of the Journal, I suppose I would say as much. So, let me instead put them in context, because the purpose of guidelines is often misunderstood. Guidelines are rarely meant to be prescriptive, especially in psychiatry, where the evidence is often incomplete or absent. The anxiety guidelines, like others before them in this series, therefore provide expert opinion and consensus-based advice alongside evidence-based recommendations, so that clinicians can at least have some information to draw upon when making difficult decisions regarding diagnosis and management. This is always hard to achieve, but ultimately it is essential if guidelines are to have any value. To this end, the anxiety guidelines provide clear recommendations, where possible, and indicate how these have been formulated. Summaries are also provided, together with figures and tables/diagrams, making the recommendations easier to understand and follow.

When you eventually turn to the CPGs themselves, some of you will no doubt be surprised to learn that they do not address obsessive compulsive disorders and related illnesses. This is, in part, because of changes that have occurred in our taxonomies, and indeed our scientific thinking, as to where these disorders might sit. But it is also perhaps a pragmatic decision, given that so much more is now known about obsessional disorders that they probably deserve separate consideration altogether. I close my account of the anxiety CPGs with their opening line: ‘anxiety is normal’. Indeed, some degree of anxiety is essential and so, given the holiday period weighing heavily upon us, it is just as well that we have these guidelines at hand.

Another key article in this issue, and one that again reflects the collaborative effort of a large number of people, is the AREDOC initiative ‘penned’ by Parker et al. (this issue). This document reflects in part the growing individual and collective misgivings academics and clinicians have worldwide as regards our current classificatory systems. The focus of this paper is bipolar disorders as definied in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). This is a good starting point, as bipolar disorders invariably branch out from mood disorders to personality, psychosis and anxiety disorders – overlapping inevitably with all of these. The paper reflects the foundation upon which this group aims to conduct further research with the aim of achieving more meaningful diagnostic descriptors that not only reflect real-world clinical presentations, but also inform clinical management. Again, reading this article will be a worthwhile investment of your time but, once again, as a participant in this project, I am bound to say this! Hence, it would be all the more useful to have your feedback and your opinions, which can be expressed as correspondence to the Journal.

Finally, and it is indeed the final ‘over’, we turn to the Ashes; the Psychiatry Ashes. These have been played in good spirits and they have served to kindle interest in academia and inject a little fun into the pages of ANZJP and its sister journal the British Journal of Psychiatry (BJPsych). I therefore take this opportunity to thank my counterpart Professor Kamaldeep Bhui, Editor of our sibling journal for his ready acceptance of my proposal and for being a good sport throughout. Scoring in the game has proven to be rather uneven, perhaps somewhat due to chance (see Ashes Update, Malhi and Bhui, this issue). But in a year where the actual sport of cricket came under great scrutiny and criticism, it has been useful to have an endeavour that instils teamwork and a healthy sense of competition. And though there are no formal prizes for the Psychiatry Ashes, I feel all those that participated have ‘urn’d’ an award by simply playing.