{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:01:32Z","timestamp":1785474092733,"version":"3.56.0"},"reference-count":14,"publisher":"Royal College of Psychiatrists","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych Bull"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Clinical guidelines aid decision-making, but their simplifying strength becomes a limitation in complex, value-laden situations. Once meant to summarise evidence, they now function as prescriptive standards used in quality and legal assessments. Overly rigid directives can undermine autonomy, hide uncertainty and restrict clinical judgement. Using complexity science and \u2018wicked problem\u2019 theory, we introduce \u2018wicked complexity\u2019 to better match guidelines design to real clinical challenges. Applying this to deprescribing psychoactive drugs, we show how traditional, adherence-focused guidance can prompt defensive practice. Guidelines for wicked complexity should instead clarify risks, support moral deliberation and support shared, iterative decision-making across healthcare.<\/jats:p>","DOI":"10.1192\/bjb.2026.10271","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:57:17Z","timestamp":1785473837000},"page":"1-4","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Clinical guidelines addressing complex and \u2018wicked\u2019 problems"],"prefix":"10.1192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7437-6102","authenticated-orcid":false,"given":"Helene","family":"Speyer","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/035b05819","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Copenhagen"},{"name":"Copenhagen Research Centre for Mental Health \u2013 CORE, Bispebjerg and Frederiksberg Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marte","family":"Ustrup","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/035b05819","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Copenhagen"},{"name":"Copenhagen Research Centre for Mental Health \u2013 CORE, Bispebjerg and Frederiksberg Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Roe","sequence":"additional","affiliation":[{"name":"University of Haifa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3515-3993","authenticated-orcid":false,"given":"Awais","family":"Aftab","sequence":"additional","affiliation":[{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"S205646942610271X_ref5","doi-asserted-by":"publisher","DOI":"10.1007\/BF01405730"},{"key":"S205646942610271X_ref2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.0097"},{"key":"S205646942610271X_ref8","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000430"},{"key":"S205646942610271X_ref3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g3725"},{"key":"S205646942610271X_ref11","volume-title":"The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia","year":"2021"},{"key":"S205646942610271X_ref9","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2025.1702"},{"key":"S205646942610271X_ref12","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291724002678"},{"key":"S205646942610271X_ref6","unstructured":"6 Snowden, DJ , Boone, ME. Leader\u2019s Framework for Decision Making. Harvard Business Impact, 2007 (https:\/\/hbsp.harvard.edu\/product\/R0711C-PDF-ENG)."},{"key":"S205646942610271X_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(24)00334-1"},{"key":"S205646942610271X_ref1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.20250230"},{"key":"S205646942610271X_ref7","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001612"},{"key":"S205646942610271X_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(25)00031-8"},{"key":"S205646942610271X_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2016.10.009"},{"key":"S205646942610271X_ref14","doi-asserted-by":"publisher","DOI":"10.1038\/s41537-026-00745-y"}],"container-title":["BJPsych Bulletin"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S205646942610271X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:57:18Z","timestamp":1785473838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S205646942610271X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":14,"alternative-id":["S205646942610271X"],"URL":"https:\/\/doi.org\/10.1192\/bjb.2026.10271","relation":{},"ISSN":["2056-4694","2056-4708"],"issn-type":[{"value":"2056-4694","type":"print"},{"value":"2056-4708","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}