Therapeutic standards in psychopharmacology and medical decision-making

Treatment surveys regularly show deviations of routine treatment from treatment guidelines. An analysis of the scientific basis of classical treatment standards, as derived from controlled treatment trials, shows that they do not take into account many variables with major impact on routine treatment. A better theoretical framework for understanding medical decision-making under complex stimulus conditions is provided by action theory. Studies that test treatment strategies instead of treatments and field observational studies, for both of which examples are given, are necessary adjuncts to controlled clinical trials in the quest for more scientifically based treatment guidelines.