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 this form or by direct email to guidelines@psych.org. Please include “topic nomination” in the subject of your email.
Draft Guidelines
As draft APA guidelines become available for review, they may be downloaded here. No drafts are currently available.
Clinical Questions available for review
As clinical questions for guidelines under development become available for review, they may be viewed here. No clinical questions are currently available for comment.
Clinical Questions Recently Reviewed
APA is currently developing practice guidelines to address the psychiatric evaluation of adults. These are questions only, they are not guideline recommendations. The review period for these questions is now closed.
Risk Assessment
1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, is identification of risk for suicide improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of the following?
- Current suicidal ideas, including active or passive thoughts of suicide or death
- Current suicidal plans
- Current suicidal intent
- Intended course of action if current symptoms worsen
- Prior suicide ideas or plans
- Prior suicide attempts
- Prior aborted or interrupted suicide attempts (in which an attempt was stopped by the individual or by someone else)
- Prior intentional self-injury without suicide intent
- History of psychiatric hospitalization
- History of suicidal behaviors in biological relatives
- Anxiety symptoms, including panic attacks
- Hopelessness
- Impulsivity
- Accessibility of suicide methods, including firearms
- Current or recent dependence, abuse, or increased use of alcohol or other substances
- Presence of possible motivations for suicide (e.g., attention or reaction from others, revenge, shame, humiliation, delusional guilt, command hallucinations)
- Presence or absence of psychosocial stressors (e.g., financial, housing, legal or school/occupational problems; lack of social support)
- Presence or absence of reasons for living (e.g, sense of responsibility to children or others, religious beliefs)
- Quality and strength of the therapeutic alliance
2. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, is identification of risk for aggressive behaviors improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of the following?
- Current aggressive ideas, including thoughts of physical or sexual aggression or homicide
- Prior homicidal or aggressive behaviors, including domestic or workplace violence or other physically or sexually aggressive threats or acts
- Prior homicidal or aggressive ideas
- History of psychiatric emergency visits or psychiatric hospitalization
- Legal or disciplinary consequences of aggressive behaviors, including school expulsion, arrests, or orders of protection
- Current or recent dependence, abuse, or increased use of alcohol or other substances
- Impulsivity, including anger management issues
- Access to firearms
- Psychosocial stressors (e.g., financial situation, housing/homelessness, lack of social support)
- Family history of abuse or violence
- Exposure to violence or aggressive behavior, including combat exposure
- Neurological disorder (e.g., traumatic brain injury, seizure)
Substance Use Assessment
1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are identification and diagnosis of substance use disorders improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessments of the following?
- Current tobacco use
- Current alcohol use
- Current use of other substances (e.g., marijuana, cocaine, heroin, psychomimetics)
- Current misuse of prescribed or over-the-counter (OTC) medications or supplements
- Past tobacco use
- Past alcohol use
- Past use of other substances (e.g., marijuana, cocaine, heroin, psychomimetics)
- Past misuse of prescribed or OTC medications or supplements
Cultural Assessment
1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, is formulation of an appropriate treatment plan improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of his or her language needs (i.e., basic language ability and need for an interpreter)?
2. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are the following improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of his or her personal/cultural beliefs?
Personal/cultural beliefs are defined as beliefs related to the patient's personal/cultural characteristics and identity, including but not limited to beliefs about age, ethnicity, gender, race, religion, and sexuality.
- Therapeutic alliance
- Accuracy of diagnosis
- Formulation of an appropriate treatment plan
3. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are the following improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of his or her cultural explanations of psychiatric illness?
- Therapeutic alliance
- Accuracy of diagnosis
- Formulation of an appropriate treatment plan
4. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are the following improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of cultural factors related to his or her social environment (e.g., family network, work place, religious group, community, or other psychosocial support network)?
- Therapeutic alliance
- Accuracy of diagnosis
- Formulation of an appropriate treatment plan
General Medical Health
1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, should an initial psychiatric evaluation typically (i.e., almost always) include assessment of whether or not the patient has an ongoing relationship with a primary care health professional?
2. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are diagnostic accuracy and treatment safety improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of the following aspects of his or her current general medical status?
"Assessment" is defined here as (a) performing a physical examination on the patient, (b) directing another clinician (e.g., a resident) to perform the exam, or (c) reviewing the results of a recent physical examination performed by another clinician.
- 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
- Involuntary movements or abnormalities of motor tone
- Coordination and gait
- Speech, including fluency and articulation
- Cranial nerves, including sight and hearing
- Reflexes and peripheral motor and sensory functions
3. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are diagnostic accuracy and treatment safety improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of the following aspects of his or her general medical history? Assessment may occur directly or by review of the results of a recent assessment by another clinician.
- 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 sexually transmitted diseases, 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
4. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are diagnostic accuracy and treatment safety improved when the initial psychiatric evaluation typically (i.e., almost always) includes review of all medications he or she is currently or recently taking and the side effects of these medications?
"All medications" means both prescribed and non-prescribed medications, herbal and nutritional supplements, and vitamins.
5. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are diagnostic accuracy and treatment safety improved when the initial psychiatric evaluation typically (i.e., almost always) includes the following elements of a review of systems?
- General/systemic
- Skin
- HEENT (head, ears, eyes, nose, throat)
- Respiratory
- Cardiovascular
- Gastrointestinal
- Genitourinary
- Musculoskeletal
- Neurologic
- Hematologic
- Endocrine
Review of Psychiatric Systems and Treatment History
1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are accuracy of diagnosis and appropriateness of treatment selection improved when the initial psychiatric evaluation typically (i.e., almost always) includes review of the following?
- Psychiatric systems, including mood, anxiety, thought content and process, perceptual and cognitive problems, and trauma history
- 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
Documentation
1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, is an individual clinician’s decision-making about a patient’s psychiatric diagnosis and treatment plan improved when the clinician typically (i.e., almost always) documents the following in the patient’s medical record? Is coordination of psychiatric treatment with other clinicians improved?
- Rationale for clinical tests (e.g., laboratory studies, imaging, ECG, EEG) as part of the initial evaluation
- Rationale for treatment selection, including discussion of the specific factors that influenced the treatment choice
- Estimation of suicide risk, including factors influencing risk
- Estimation of risk of aggressive behavior (including homicide), including factors influencing risk
Quantitative Assessment
1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, is clinical decision-making improved when quantitative measures of the following are typically (i.e., almost always) obtained within the scope of the initial psychiatric evaluation, as compared to non-quantitative clinician assessment?
"Quantitative measures" are defined as clinician- or patient-administered tests or scales that provide a numerical rating of features such as symptom severity, level of functioning, or quality of life and have been shown to be valid and reliable.
- Symptoms
- Level of functioning
- Quality of life
2. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are clinical decision-making and treatment outcomes improved when quantitative measures of the following are typically (i.e., almost always) obtained on at least one occasion after the initial psychiatric evaluation, compared to non-quantitative clinician assessment?
- Symptoms
- Adverse effects of treatment
- Level of functioning
- Quality of life
Involvement of the Patient in Treatment Decision-Making
1. For patients who present with a psychiatric symptom, sign, or syndrome in any setting and have the capacity for decision-making, are the therapeutic alliance and treatment adherence improved by explaining the following?
- The diagnosis
- Risks of untreated illness
- Treatment options
- Benefits and risks of treatment
2. For patients who present with a psychiatric symptom, sign, or syndrome in any setting and have the capacity for decision-making, are the therapeutic alliance and treatment adherence improved by asking about treatment-related preferences?
3. For patients who present with a psychiatric symptom, sign, or syndrome in any setting and have the capacity for decision-making, are the following improved by "shared decision-making"?
Shared decision-making is defined as collaboration between clinicians and patients about decisions pertinent to treatment, when the patient has capacity for decision-making.
- Treatment adherence
- Therapeutic alliance
- Clinician satisfaction
- Patient satisfaction