Authors’ Response, “Reply to the comments on Reporting guidelines for Case Reports In Mental health and Psychiatry (CRIMP)”

The points raised are relevant, with reference to the CRIMP guidelines, which were developed through expert review and consensus using a Delphi method. It has been pointed out that the expert recruitment process is unclear and does not follow widely accepted guidelines, such as the Conducting and Reporting of Delphi Studies (CREDS).1 Moreover, certain issues were not addressed, such as the sampling strategy and recruitment process, specifically the demographic and professional composition of the expert panel (e.g. gender, geography, career stage), whose absence may limit transparency, methodological rigor, and representativeness.2 We would like to highlight the core principles of the Delphi technique as a research method, including its strengths, and limitations. Essentially, the Delphi method is used to achieve consensus among experts on complex, uncertain topics. It is a structured forecasting approach that relies on panel members’ collective judgments. Currently, there are no universal quality standards for Delphi methods in healthcare research. Important features include anonymity, multiple rounds, feedback, and the aim of reaching a stable consensus. Many studies employ modified Delphi approaches but often lack details on panel selection, the consensus process, or the criteria for concluding the process. The Delphi technique used to develop the CRIMP guideline primarily adheres to the key elements of anonymity, repeated rounds, feedback, and consensus building.3–5 As outlined in the methodology, experts were recruited based on their research experience, and were drawn from diverse geographic areas, institutional types, and career stages. Their responses were kept anonymous throughout, and several steps were taken to build consensus. The limited gender representation may be an unintentional constraint. However, failing to follow the CREDS guidelines also represent a limitation. We highlight the limitation of SCRIBE in not covering adverse events specifically focused on behavioral interventions, which do not address many relevant aspects, such as novel presentations. The CRIMP attempted to mitigate these shortcomings. The reviewer’s suggestions for using a standardized tool to address adverse reactions, such as the Naranjo Adverse Drug Reaction Probability Scale, is well taken and can included in subsequent versions of CRIMP. We acknowledge the point raised and clarify that the use of the CRIMP guideline was justified, considering the diverse documentation practices in mental health and psychiatry case reports. While reporting a single case or multiple cases varies in format and often requires conciseness due to word limits, CRIMP cannot entirely address these limitations. Its objective was to bring uniformity in reporting standards and consistency, although CRIMP is intended to promote consistency in case reporting, it cannot fully resolve these challenges. The term CRIMP is an acronym established during the Delphi discussion and feedback process, with expert approval for including case series. The limit of ten cases for defining a case series was chosen after reviewing several case series, with a somewhat arbitrary higher threshold. Including case series under CRIMP provides flexibility and enhances consistency in case reporting within mental health and psychiatry. We acknowledge the reviewer’s suggestion and have rephrased the ethical statement to reflect that the article has an ethical exemption, permitting the extensive use of CRIMP due to the involvement of human participants. We recognize that CRIMP guideline authors are currently limited to one country and ideally should include global representation. This is a common limitation seen in other guidelines as well. Addressing this issue will depend on future feasibility considerations. In summary, we recognize most points raised by the reviewer, which will strengthen the CRIMP guideline’s structure. Due to the limitations of the Delphi method used for development, it is important to ensure fair representation of experts and geographic diversity to address these issues. Additionally, maintaining clear and consistent case reporting standards in mental health and psychiatry is essential, and a guideline like CRIMP will support this goal. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.