Guideline Topics, Draft Clinical Questions and Draft Guidelines

The APA invites comments throughout the practice guideline development process. On this page, APA members and other stakeholders may review potential guideline topics, clinical questions for guidelines under development, and draft guidelines.

Guideline Topics

APA selects topics for development of a practice guideline according to the following criteria:

  • Degree of public importance (prevalence and seriousness)
  • Relevance to psychiatric practice
  • Availability of systematic reviews of available evidence
  • Likelihood that a guideline would improve practice and patient care
  • Time since publication of practice guidelines on the topic by APA or other organizations
APA members and stakeholders may suggest topics for future APA guideline development using the form below (under "Resources") or by direct email to guidelines@psych.org. Please include “topic nomination” in the subject of your email. 

Clinical Questions for Guidelines Under Development 

As clinical questions become available for review, they may be viewed here. No clinical questions are currently available for comment. 

Draft Guidelines

As draft APA guidelines become available for review, they may be downloaded here. No drafts are currently available. 

Clinical Questions Recently Reviewed

APA is currently developing practice guidelines to address the topics and clinical questions below. The review period for these topics is now closed.  

Topic: Quantitative assessment

  1. For patients with a psychiatric symptom, sign, or syndrome treated in inpatient and outpatient settings, does obtaining initial quantitative measures (within 30 days of initial presentation) of the patient’s (a) clinical status, (b) symptoms, (c) level of functioning, and (d) quality of life improve clinical decision-making, compared to a non-quantitative clinician assessment?
  2. For patients receiving treatment for a psychiatric disorder in inpatient and outpatient settings, does obtaining quantitative measures of the patient’s (a) clinical status, (b) symptoms, (c) adverse effects of treatment, (d) level of functioning, and (e) quality of life on at least one occasion after the initial evaluation improve clinical decision-making and treatment outcomes, compared to non-quantitative clinician assessment?
Topic: Substance use assessment
  1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, do initial evaluations that include assessment for (a) current tobacco use, (b) current alcohol use, (c) current misuse of prescribed or over-the-counter medications or supplements, (d) current use of other substances, (e) past tobacco use, (f) past alcohol use, (g) past misuse of prescribed or over-the-counter medications, and (h) past use of other substances improve the identification and diagnosis of substance use disorders?
Topic: Cultural assessment
  1. For patients being evaluated for a psychiatric disorder, does assessment of the patient’s personal/cultural beliefs about his or her psychiatric symptoms (i.e., beliefs related to personal/cultural characteristics including religion, race, ethnicity, and age) improve the therapeutic alliance?
  2. For patients in treatment for a psychiatric disorder, does assessment of the patient’s personal/cultural beliefs about his or her psychiatric symptoms (i.e., beliefs related to personal/cultural characteristics including religion, race, ethnicity, and age) improve formulation of an appropriate treatment plan?
  3. For patients in treatment for a psychiatric disorder, does assessment of the patient’s language needs (i.e., the patient’s basic language ability and need for an interpreter) improve formulation of an appropriate treatment plan?
Topic: Involvement of the patient in treatment decision-making
  1. For patients with a psychiatric symptom, sign or syndrome and with the capacity for decision-making, does asking the patient about his or her preferences about available treatment options improve therapeutic alliance and treatment adherence?
  2. For patients with a psychiatric symptom, sign or syndrome and with the capacity for decision-making, does explaining to the patient (a) the diagnosis, (b) risks of untreated illness, (c) treatment options, and (d) potential benefits and risks of treatments improve therapeutic alliance and treatment adherence? 
  3. For patients with a psychiatric symptom, sign or syndrome and with the capacity for decision-making, does shared decision-making (i.e., collaboration between patient and clinician about decisions pertinent to treatment) improve treatment adherence, therapeutic alliance, clinician satisfaction, and patient satisfaction? 

Topic: Assessment of risk for suicide

  1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, do initial evaluations that include assessment of the following improve identification of patients at risk for suicide:
    • current suicidal ideas – including active or passive thoughts of suicide or death,
    • prior suicide attempts,
    • aborted suicide attempts (sometimes termed suicide rehearsals, in which steps to a suicide attempt are taken but the attempt is interrupted or not carried out),
    • prior self-injury without suicide intent,
    • prior suicidal ideas,
    • history of psychiatric hospitalization,
    • substance use, current or recent,
    • hopelessness,
    • impulsivity, and
    • accessibility of firearms?
  2. For patients who have current suicidal ideation, do initial evaluations that also include assessment of the following improve identification of degree of risk for suicide:
    • current suicidal plans,
    • behaviors that relate to taking action on a suicidal plan
    • current suicidal intent,
    • prior suicidal plans,
    • most severe suicidal plan or attempt,
    • knowledge of lethality of planned methods,
    • hopelessness
    • impulsivity
    • accessibility of suicide methods including firearms,
    • presence or absence of reasons for living (e.g., sense of responsibility to children or others, religious beliefs),
    • family history of suicidal behaviors in biological relatives,
    • whether the patient presented for evaluation of his or her own volition,  
    • psychosocial stressors (e.g., financial situation, housing/homelessness, lack of social support)?
  3. For patients who have prior suicide attempts, aborted suicide attempts, or self-injury without suicide intent, do initial evaluations that also include assessment of the following improve identification of degree of risk for suicide:
    • most severe suicidal plan or attempt,
    • other prior suicidal plans, attempts, aborted attempts, or self-injury,
    • degree of suicidal intent at the prior attempt(s) or aborted attempt(s),
    • estimated medical lethality of planned or attempted method(s),
    • patient’s expectation of lethality of planned or attempted method(s),
    • factors that contributed to patient’s survival following suicide attempts or aborted suicidal attempts (e.g., patient sought help, serendipitous rescue),
    • patient’s sense of regret or relief about survival after prior attempt(s),
    • relationship of suicide attempts, aborted attempts, or self-injury to intoxication,
    • hopelessness,
    • impulsivity,
    • current accessibility of suicide methods, including firearms,
    • psychosocial stressors (e.g., financial situation, housing/homelessness, lack of social support)?

Topic: Assessment of general medical health

  1. Are diagnostic accuracy and treatment safety improved when an initial psychiatric evaluation includes assessment of the following aspects of the patient’s general medical health, either by direct assessment or by review of the results of a recent assessment by another clinician?
    • The patient’s current general medical status, as determined by examination
      • General appearance and nutritional status
      • Height, weight, body mass index (BMI)
      • Vital signs
      • Skin, including any stigmata of trauma, self-injury, or drug use
      • Cardiopulmonary status
      • Neurological status (including [a] Involuntary movements or abnormalities of motor tone, [b] Coordination and gait, [c] Cranial nerves, including sight and hearing, and [d] Other aspects of neurological status, including speech, reflexes, and peripheral motor sensory functions)
    • The patient’s general medical history
      • Physical trauma including head injuries
      • Past or current general medical illnesses and related hospitalizations
      • Important past or current treatments or procedures, including complementary and alternative medical treatments
      • Allergies or drug sensitivities
      • Past or current endocrinological disease
      • Past or current infectious disease, including but not limited to HIV, tuberculosis, and hepatitis C
      • Past or current neurological disorders or symptoms
      • Sexual and reproductive history
      • Past or current sleep disorders, including sleep apnea
      • Past or current symptoms or conditions associated with significant pain and discomfort
    • All medications the patient is currently or recently taking, both prescribed and over the counter, including hormones (e.g., birth control pills, androgens), herbal supplements, and vitamins, and the side effects of these medications 
    • Review of Systems
      • General/systemic
      • Skin
      • HEENT (head, ears, eyes, nose, throat)
      • Respiratory
      • Cardiovascular
      • Gastrointestinal
      • Genitourinary
      • Musculoskeletal
      • Neurologic
      • Hematologic
      • Endocrine

Topic: Review of psychiatric systems and treatment history

  1. For patients with a psychiatric symptom, sign, or syndrome who are evaluated in any setting, does a review of the following improve accuracy of diagnosis and appropriateness of treatment selection, compared with no review?
    • Psychiatric review of systems, including review of mood, anxiety, thought content and process, and perceptual and cognitive problems 
    • Previous psychiatric diagnoses (both principal and working)
    • Past psychiatric treatment trials (type, duration and, where applicable, doses)
    • Adherence to past psychiatric treatments, including both pharmacological and non-pharmacological treatments
    • Response to past psychiatric treatments

Topic: Documentation

  1. For patients who are receiving a psychiatric evaluation, does documentation of the following improve the provision of appropriate treatment? The coordination of treatment?  
    • Factors influencing treatment selection
    • Rationale for treatment selection
    • Education on the risks and benefits of treatment options given to the patient, family, or others involved in the patient’s care
    • Estimation of suicide risk, including factors influencing risk
    • Estimation of risk of aggressive behavior (including homicide), including factors influencing risk