The Guideline's recommendations are contained in twenty-four statements that cover treatment with antipsychotic medications, management of side effects, treatment resistance, management of suicide risk, management of aggression, psychotherapeutic and rehabilitative treatments.
Full Answer
What are APA guidelines for the treatment of psychiatric disorders?
APA guidelines generally describe treatment of adult patients. For the treatment of children and adolescents with psychiatric disorders, practice guidelines, updates, and parameters are available from the American Academy of Child and Adolescent Psychiatry.
What is the purpose of the initial psychiatric evaluation?
The initial psychiatric evaluation may set the stage for such ongoing care by establishing initial treatment goals, gathering relevant baseline data, estab- lishing a plan for systematic follow-up assessment using formal but practical and relevant mea- sures, and ensuring longitudinal follow-up.
What are the different types of clinical psychiatric evaluations?
Three types of clinical psychiatric evaluations are discussed: 1) general psychiatric evaluation, 2) emergency evaluation, and 3) clinical consultation. In addition, general principles to guide the conduct of evaluations for administrative or legal purposes are reviewed.
How do you develop American Psychiatric Association practice guidelines?
American Psychiatric Association Practice Guidelines. Steps in the development process include establishing transparency, managing conflicts of interest, composing work groups, using systematic reviews of evidence, articulating and rating recommendations in guidelines, obtaining external review, and updating.
What are the key elements of good mental health policy?
Some common aims for mental health policy include the promotion of mental health, reduction of incidence and prevalence of mental disorder (prevention and treatment), reduction of the extent and severity of associated disability (rehabilitation), development of services for people with mental illness and reduction of ...
What are essential elements of the psychiatric assessment?
Evaluation may include:Description of behaviors (like when do the behaviors happen, how long does the behavior last, what are the conditions in which the behaviors most often happen)Description of symptoms (physical and psychiatric symptoms)Effects of behaviors or symptoms related to: ... Psychiatric interview.More items...
What is one of the important domains of mental health framework?
Seven domains important to quality of life for people with mental health problems were identified: well-being and ill-being; relationships and a sense of belonging; activity; self-perception; autonomy, hope and hopelessness; and physical health.
Which interventions are the most important in the treatment of mental illness?
1. Mental Health Crisis Intervention. One of the most important types of interventions includes mental health crisis intervention.
What are the 4 main components of a mental status exam?
What are The four main components of the mental status assessment? And the Acronym to help remember? are appearance, behavior, cognition, and thought processes.
What are the components of psychiatric history?
Acquiring a psychiatric history follows the same format as any medical history, with particular emphasis on developmental and social factors. It must also include the patient's past mental health history, including treatment and medications, and a history of family psychiatric disorders and treatment.
What are the 3 main social determinants of mental health?
A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life.
What are the 7 components of mental health?
7 Components of Mental HealthIn-person therapy. ... Community. ... Physical health. ... Intellectual health. ... Environmental health. ... Boundaries. ... Self care.
What are the 3 determinants of mental health?
When it comes to mental health, three social determinants are particularly significant: freedom from discrimination and violence. social inclusion. access to economic resources.
Why is treatment important for mental illness?
Without treatment, the consequences of mental illness for the individual and society are staggering. Untreated mental health conditions can result in unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, and suicide, and poor quality of life.
What is the importance of prevention in mental health care?
Prevention is an important approach to improving mental health. It means stopping mental health problems from developing, getting worse or coming back.
What are the possible treatment techniques of psychological disorder?
Types of psychological treatmentAcceptance and commitment therapy. ... Cognitive analytic therapy. ... Cognitive behaviour therapy. ... Dialectical behaviour therapy. ... Family therapy. ... Group therapy. ... Interpersonal therapy. ... Mentalisation-based therapy.More items...
Primer
Clinical Practice Guidelines (CPGs) (“Evidence-based guidelines”) are systematically developed statements to assist clinicians and patient in making decisions about appropriate health care for specific clinical circumstances. Often times, CPGs have an algorithmic or flow chart approach to help clinicians make decisions.
Bipolar
See also: Parker, G. B., Graham, R. K., & Tavella, G. (2017). Is there consensus across international evidence‐based guidelines for the management of bipolar disorder?. Acta Psychiatrica Scandinavica, 135 (6), 515-526.
Resources
CMPA: Clinical practice guidelines — Guidance or a standard of practice?
What is APA guidelines?
APA guidelines generally describe treatment of adult patients. For the treatment of children and adolescents with psychiatric disorders, practice guidelines, updates, and parameters are available from the American Academy of Child and Adolescent Psychiatry.
What is APA practice?
APA practice guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders and are intended to assist in clinical decision making by presenting systematically developed patient care strategies in a standardized format. APA makes the practice guidelines freely available to promote their dissemination ...
What is the purpose of the schizophrenic guideline?
The goal of this guideline is to improve the quality of care and treatment outcomes for patients with schizophrenia, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition ( American Psychiatric Association 2013 ). Since publication of the last full practice guideline ( American Psychiatric Association 2004) and guideline watch ( American Psychiatric Association 2009) on schizophrenia, there have been many studies on new pharmacological and nonpharmacological treatments for schizophrenia. Additional research has expanded our knowledge of previously available treatments. The guideline focuses specifically on evidence-based pharmacological and nonpharmacological treatments for schizophrenia but also includes statements related to assessment and treatment planning that are an integral part of patient-centered care ( Box 1 ).
What is the DSM-5 for schizophrenia?
The scope of this practice guideline is shaped by the Treatments for Schizophrenia in Adults ( McDonagh et al. 2017 ), a systematic review that was commissioned by the Agency for Healthcare Research and Quality (AHRQ) and that serves as a principal source of information for the guideline. The AHRQ review uses the DSM-5 definition of schizophrenia; however, many of the systematic reviews included studies that used earlier DSM or International Classification of Disease criteria for schizophrenia. Several studies, particularly those assessing harms and psychosocial interventions, also included patients with a schizophrenia spectrum disorder diagnosis. Consequently, discussion of treatment, particularly treatment of first-episode psychosis, may also be relevant to individuals with schizophreniform disorder.
What is a grade in a guideline?
This concept of balancing benefits and harms to determine guideline recommendations and strength of recommendations is a hallmark of Grading of Recommendations Assessment, Development and Evaluation (GRADE), which is used by multiple professional organizations around the world to develop practice guideline recommendations ( Guyatt et al. 2013 ). With the GRADE approach, recommendations are rated by assessing the confidence that the benefits of the statement outweigh the harms and burdens of the statement, determining the confidence in estimates of effect as reflected by the quality of evidence, estimating patient values and preferences (including whether they are similar across the patient population), and identifying whether resource expenditures are worth the expected net benefit of following the recommendation ( Andrews et al. 2013 ).
What is the assessment of benefits and risks of antipsychotic treatment for the patient?
APA recommends that nonemergency antipsychotic medication should only be used for the treatment of agitation or psychosis in patients with dementia when symptoms are severe, are dangerous, and/or cause significant distress to the patient.
Why is a practice guideline for dementia important?
A practice guideline for this subject is needed because of the prevalence of dementia in the older adult population, the common occurrence of agitation and psychotic symptoms among patients with dementia, the variability in current treatment practices, and the risks associated with some forms of treatment.
What are the factors that contribute to agitation?
These include the patient’s likes and dislikes, lifestyle, hobbies, personality traits, intimacy and relationship patterns, spiritual and cultural beliefs, and past and current life circumstances.
What are the costs of assessment, treatment planning, and discussions with patients, family, or other surrogate decision makers?
The costs of assessment, treatment planning, and discussions with patients, family, or other surrogate decision makers relate to clinician time. Discussions with family or surrogate decision makers can also introduce direct or indirect costs to those individuals (e.g., lost work time, transportation). The feasibility of any treatment must also consider the unique situation of the patient and family, such as access to transportation, insurance status and coverage for specific services, and the effects of treatment requirements on the caregiver’s time or employment.
What is the purpose of initial assessment for dementia?
In individuals with dementia, as in any patient who presents with a psychiatric symptom, an initial assessment serves as a foundation for further evaluation and treatment planning ( American Psychiatric Association 2015b ). Assessing the type, frequency, severity, pattern, and timing of symptoms such as agitation and psychosis can help in identifying possible contributors and in targeting interventions to address symptoms and their causes. Pain is a common contributor to agitation or aggression and may signal other physical conditions, which may also need intervention. It is similarly important to determine the subtype (s) of dementia that is present, as this has implications for treating behavioral/psychological symptoms as well as providing information on likely disease course. The initial assessment also provides baseline information on symptoms, which is relevant to tracking of symptom progression or effects of intervention. Use of a quantitative measure to document information on symptoms in a systematic fashion can be helpful in monitoring the patient’s progress and assessing effects of treatment. A comprehensive treatment plan, as an outgrowth of the initial assessment, is beneficial in fostering a thorough review of the patient’s clinical presentation and in reviewing potential options for care that are person-centered and aimed at improving overall quality of life. Discussing the benefits and risks of possible treatments with the patient and surrogate decision makers is valuable in engaging them and helping them make informed decisions. Such discussions can also be beneficial by providing education on dementia and its symptoms and on available therapeutic options.
What is the APA statement for dementia?
APA recommends that if a patient with dementia experiences a clinically significant side effect of antipsychotic treatment, the potential risks and benefits of antipsychotic medication should be reviewed by the clinician to determine if tapering and discontinuing of the medication is indicated.
What is the purpose of APA statement 5?
APA recommends that nonemergency antipsychotic medication should only be used for the treatment of agitation or psychosis in patients with dementia when symptoms are severe, are dangerous, and/or cause significant distress to the patient. (1B)
What is the summary of treatment recommendations?
recommendation, the summary of treatment recommen- dations is keyed according to the level of confidence with which each recommendation is made. Each rating of clin- ical confidence considers the strength of the available ev- idence. When evidence from randomized controlled trials and meta-analyses is limited, the level of confidence may also incorporate other clinical trials and case reports as well as clinical consensus with regard to a particular clinical decision. In the listing of ci ted references, each reference is followed by a letter code in brackets that indicates the nature of the supporting evidence.
What are the parts of the practice guideline for the treatment of patients with ma-jor depressive disorder?
The Practice Guideline for the Treatment of Patients With Ma- jor Depressive Disorder, Third Edition,consists of three parts (Parts A, B, and C ) and many sections, not all of which will be equally useful for all readers. The following guide is designed to help readers find the sections that will be most useful to them. Part A, “Treatment Recommendations,” is published as a supplement to the American Journal of Psychiatryand contains general and specific treatment recommenda- tions. Section I summarizes the key recommendations of the guideline and codes each recommendation according to the degree of clinical confidence with which the recom- mendation is made. Section II is a guide to the formula- tion and implementation of a treatment plan for the individual patient. Section III, “Specific Clinical Features Influencing the Treatment Plan,” discusses a range of clin- ical considerations that could alter the general recommen- dations discussed in Section I. Part B, “Background Information and Review of Avail- able Evidence,” and Part C, “Future Research Needs,” are not included in the American Journal of Psychiatrysup- plement but are provided with Part A in the complete guide- line, which is available in print format from American Psychiatric Publishing, Inc., and online through the Ameri- can Psychiatric Association (http://www.psychiatryon- line.com). Part B provides an overview of major depressive disorder, including general information on natural history, course, and epidemiology. It also provides a structured review and synthesis of the evidence that underlies the recommendations made in Part A. Part C draws from the previous sections and summarizes areas for which more research data are needed to guide clinical decisions. To share feedback on this or other published APA practice guidelines, a form is available at http://mx.psych.org/survey/reviewform.cfm.
What is a level III rating for psychodynamic therapy?
dynamic psychotherapy in individuals with major depres- sive disorder, the Work Group gave this treatment a level III rating, i.e., “may be recommended on the basis of in- dividual circumstances.” The Steering Committee gave a level II rating, “recommended with moderate clinical confi- dence,” based on the long history of clinical experience with psychodynamic psychotherapy as well as findings from several studies of patients who had depressive symp- toms but not major depressive disorder per se. Relevant updates to the literature were identified through a MEDLINE literature search for articles published since the second edition of the guideline, published in 2000. For this edition of the guideline, literature was identified through a computerized search of MEDLINE, using Pub- Med, for the period from January 1999 to December 2006. Using the MeSH headings depression or depressive disor- der, as well as the key words major depression, major de- pressive disorder, neurotic depression, neurotic depressive, dysthymia, dysthymic, dysthymic disorder, endogenous de- pression, endogenous depressive, melancholia, melan- cholic, psychotic depression, atypical depression, seasonal depression, postpartum depression, postpartum depressive symptoms, unipolar depression, unipolar depressive, or pseudodementia yielded 39,157 citations. An additional 8,272 citations were identified by using the key words de- pression or depressive in combination with the MeSH headings affective disorders or psychotic or the key words psychosis, psychotic, catatonic, catatonia, mood disorder, mood disorders, affective disorder, or affective disorders. These citations were limited to English language articles on human treatments using the MeSH headings central nervous system stimulants, hypnotics and sedatives, anti- convulsants, tranquilizing agents, electric stimulation ther- apy, electroconvulsive therapy, psychotherapy, antidepres- sive agents, and monoamine oxidase inhibitors or the key words antidepressant, antidepre ssants, antidepressive, anti- depressive agents, antidepressive agents, second genera- tion, antidepressive agents tricyclic, antidepressive agents, tricyclic, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, duloxetine, mirtazapine, nefazo- done, trazodone, imipramine, desipramine, nortriptyline, protriptyline, doxepin, trimipramine, amitriptyline, phe- nelzine, tranylcypromine, isocarboxazid, moclobemide, antipsychotic agents, testosterone, thyroid, tri iodothyro- nine, thyroxine, omega 3, sadenosyl methionine, sadenosyl- methionine, St. John’s wort, hypericum, selegiline, anti- convulsant, anticonvulsants, antipsychotic, antipsychotic agent, antianxiety, anti an xiety, benzodiazepine, benzodiaz- epines, zolpidem, sedative, sedatives, hypnotic, hypnotics, zaleplon, eszopiclone, valproate, valproic acid, divalproex, carbamazepine, oxcarbazepine, gabapentin, topiramate, lamotrigine, lithium, modafinil, methylphenidate, Adder- all, amphetamine, amphetamines, dextroamphetamine, atomoxetine, electroconvulsive, vagal nerve stimulation, vagus nerve stimulation, VNS, rTMS, rapid transcranial magnetic, repetitive transcranial magnetic stimulation, magnetic stimulation, deep brain stimulation, psychother- apy, psychotherapeutic, psychotherapies, behavior therapy, behaviour therapy, cognitive therapy, cognitive behavior therapy, cognitive behavioral analysis system, cognitive be- havioral therapy, cognitive behaviour therapy, cognitive behavioural therapy, psychoanalytic, interpersonal therapy, interpersonal psychotherapy, group therapy, family ther- apy, marital therapy, couples therapy, psychoanalysis, psy- chodynamic, aversive therapy, desensitization, exposure therapy, relaxation techniques, or progressive muscle relax- ation. This yielded 13,506 abstracts, which were screened for relevance with a very modest threshold for inclusion, then reviewed by the Work Group. The Psychoanalytic Electronic Publishing database (http://www.p-e-p.org) was also searched using the terms major depression or major depressive. This search yielded 112 references. The Cochrane databases were also searched for the key word depression, and 168 meta-analyses were identified. Additional, less formal, literature searches were conducted by APA staff and individual Work Group mem- bers and included references through May 2009. Sources of funding were considered when the Work Group re- viewed the literature. The broad scope of this guideline and the substantial evidence base resulted in some practical tradeoffs. One such tradeoff worth highlighting is the decision to build upon literature reviews of the first and second editions of the guideline, rather than re-do them. This decision is ac- knowledged to have resulted in an emphasis of study in this guideline on newer treatments, because the majority of studies about older treatments, including tricyclic anti- depressants and monoamine oxidase inhibitors, were pub- lished in decades prior to 1999. Readers are advised that the reviews of this older literature are described in the previous editions of the guideline. The Work Group for this edition considered the previous editions during their evidence review, but for practical reasons, that effort is less well documented than the group’s analysis of the newer literature. The treatment recommendations of this guide- line, however, were developed to reflect the complete ev- idence base. This document represents a synthesis of current scien- tific knowledge and rational clinical practice regarding the treatment of patients with major depressive disorder. It strives to be as free as possible of bias toward any theo- retical approach to treatment. In order for the reader to appreciate the evidence base behind the guideline recom- mendations and the weight that should be given to each
What are the APA guidelines?
The APA Practice Guidelines are not intended to be con- strued or to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual patient and are subject to change as scientific knowledge and technology advance and practice patterns evolve. These parameters of practice should be con- sidered guidelines only. Adherence to them will not ensure a successful outcome for every individual, nor should they be interpreted as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate recommendation regarding a particular clinical procedure or treatment plan must be made by the psychiatrist in light of the clinical data, the psy- chiatric evaluation, and the diagnostic and treatment op- tions available. Such recommendations should incorporate the patient’s personal and sociocultural preferences and val- ues in order to enhance the therapeutic alliance, adherence to treatment, and treatment outcomes. This practice guideline was approved in May 2010 and published in October 2010.
Why is it important to maintain a therapeutic alliance?
In establishing and maintaining a therapeutic alliance, it is important to collaborate with the patient in decision mak- ing and attend to the patient’s preferences and concerns about treatment [I]. Management of the therapeutic alli- ance should include awareness of transference and counter- transference issues, even if these are not directly addressed in treatment [II]. Severe or persistent problems of poor al- liance or nonadherence to treatment may be caused by the depressive symptoms themselves or may represent psy- chological conflicts or psychopathology for which psycho- therapy should be considered [II].
What is psychiatric management?
Psychiatric management consists of a broad array of inter- ventions and activities that psychiatrists should initiate and continue to provide to patients with major depressive disorder through all phases of treatment [I].
What is the APA practice guideline?
This practice guideline was developed under the direction of the Steering Committee on Practice Guidelines. The development process is detailed in a document entitled “APA Guideline Development Process,” which is avail- able from the APA Department of Quality Improvement and Psychiatric Services. Key features of this process in- clude the following: • A comprehensive literature review to identify all rele- vant randomized clinical trials as well as less rigorously designed clinical trials and case series when evidence from randomized trials was unavailable • Development of evidence tables that reviewed the key features of each identified study, including funding source, study design, sample sizes, subject characteris- tics, treatment characteristics, and treatment outcomes • Initial drafting of the guideline by a work group (“Work Group”) that included psychiatrists with clinical and re- search expertise in major depressive disorder • Production of multiple revised drafts with widespread review; 15 organizations and 71 individuals submitted comments. • Review of the final draft by an Independent Review Panel of experts with no relationships with industry, who were charged to evaluate the guideline recommen- dations for bias from potential conflicts of interest. • Approval by the APA Assembly and Board of Trustees. • Planned revisions at regular intervals. Development of this APA practice guideline was not fi- nancially supported by any commercial organization. In addition, the integrity of the guideline has been ensured by the following mechanisms: 1. Work Group members were selected on the basis of their expertise and integrity, and they agreed to dis- close all potential conflicts of interest before and during their work on this guideline to the Steering Commit- tee on Practice Guidelines and to each other. Employ- ees of industry were not included on the group, and the group was balanced to include some persons with minimal industry relationships. As disclosed on pages 2–3, from initiation of work in 2005 to approval of the guideline in 2010, some members of the Work Group on Major Depressive Disorder had relationships with industry for which they received research grants or in- come from consulting or speaking related to treat- ments discussed in the guideline. 2. Iterative guideline drafts were broadly circulated to and reviewed by the Steering Committee, other experts, al- lied organizations, and the APA membership; review- ers were asked to disclose their own potential conflicts of interest relevant to evaluating their comments. Over 1,000 comments were received and were addressed by substantive revisions by the Work Group. Oversight of the draft review and revision process was provided by the chair and vice-chair of the Steering Committee and by the Medical Editor, none of whom had relationships with industry. 3. In response to a 2009 report by the Institute of Med- icine (1), which advocated that professional organiza- tions that develop and disseminate practice guidelines should adopt a new policy that members of guideline work groups have no significant relationships with in- dustry, the following process was implemented: An independent review panel of experts (“Independent Review Panel”) having no current relationships with industry also reviewed the guideline and was charged with identifying any possible bias. The Independent Review Panel found no evidence of bias. The Work Group and the Steering Committee dif- fered on how to rate the strength of recommendation for psychodynamic psychotherapy. Based on their review of the available empirical evidence on the use of psycho-