Commentary on the ANZJP Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for the management of schizophrenia - Where are the recommendations for methamphetamine-related psychoses?

The ANZJP Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for the management of schizophrenia provide strong recommendations when high-level evidence is available. For many clinical scenarios, however, there is insufficient evidence meaning that only weak recommendations can be made using the GRADE process. Concurrent methamphetamine use in people experiencing psychosis is one such scenario. The ANZJP GRADE guidelines offer only one weak recommendation, that people with comorbid schizophrenia and substance misuse be offered psychosocial interventions. Many clinicians would value additional recommendations for this common challenge in Australian mental health services. We consider the extent of the problem of methamphetamine-related psychosis in Australia and the heterogeneity of presentations that may be managed in clinical services. We summarise the existing evidence on treatment and highlight why research in this area remains scarce. Finally, we propose the development of a consensus framework to guide treatment of methamphetamine-related psychosis and, in so doing, to enable development of high(er)-level evidence with utility in real-world clinical settings.