Practice Guidelines for the Treatment of Mental Disorders
Sam S. Hill III
Since first published in 1993 by the American Psychiatric Association, the Practice
Guidelines for the Treatment of Psychiatric Disorders (American Psychiatric Association,
2002) have established a place in mental health practice as a reliable guidepost for the
responsible treatment of mental disorders. The concept of evidence-based treatment has
only recently been popularized, but the idea has been actively explored by the American
Psychiatric Association since 1989. The original publication has been expanded to 12 of
the 12 Guidelines developed since 1993. The latest compendium, published in 2002
includes:

Practice Guideline for the Treatment of Patients With Delirium

Practice Guideline for the Treatment of Patients With Alzheimer’s Disease and other
Dementias of Late Life

Practice Guideline for the Treatment of Patients With HIV/AIDS

Practice Guideline for the Treatment of Patients With Substance Use Disorders

Practice Guideline for the Treatment of Patients With Schizophrenia

Practice Guideline for the Treatment of Patients With Major Depressive Disorder

Practice Guideline for the Treatment of Patients With Bipolar Disorder

Practice Guideline for the Treatment of Patients With Panic Disorder

Practice Guideline for the Treatment of Patients With Eating Disorders

Practice Guideline for the Treatment of Patients With Borderline Personality Disorder

Practice Guideline for the Psychiatric Evaluation of Adults

Practice Guideline Development Process
The guidelines are organized into a single volume available in paper binding or
hardbound. There is a smaller, more portable Quick Reference that summarizes the most
important elements of the larger volume. The new edition makes use of the analog
decision schematics that are found in the Diagnostic and Statistical Manual of Mental
Disorders, rev. 4th edition (DSM-IV-TR). Each practice guideline was reviewed by an
impressive list of prominent individuals and institutions nationally and internationally
known for their expertise in the particular disorder they reviewed. The Guidelines were
written by psychiatrists but hold a wealth of information for practitioners from any of the
mental health professions.
The Guidelines are presented in a common format. The exceptions to this
commonality are the specific requirements of the disorders they address. The first part of
the Guideline deals with treatment recommendations. This section presents a subsection
that summarizes the current state of the art in treatment recommendations. The next
subsection suggest the process for formulating and putting into effect a treatment plan,
and the concluding subsection of the first section examines specific clinical features that
impact the treatment plan. The second section gives a history of the disorder and reviews
the current state of science in the disorder. The first subsection defines the disorder,
referred to as the “disease,” presents its Epidemiology, Natural History, and Course. The
second subsection of the second section reviews and synthesizes the available evidence
on the disorder. The third and final section discusses future research needs in the
disorder. In the introduction to the Guidelines the American Psychiatric Association
laments the low utilization of the Guidelines by their membership but emphasizes the
importance of education and dissemination of the practice guidelines and has made this a
primary goal for that organization in the future.
The non-physician will find the guidelines to be a useful reference resource. Each
of the Guidelines concludes with a lengthy reference list of the latest and most important
research in the specific disorder addressed by the Guideline. While the approach to
treatment in the Guidelines strongly emphasizes the biological aspects of treatment there
is an overall endorsement of the Biopsychosocial approach to treatment in what is
sometimes referred to as a “whole patient” approach to treatment.
There is a wealth of information on differential diagnosis and the treatments
guidelines give ample information for those whose approach may be more one of
prescriptive eclecticism. There is broader acceptance of these treatment guidelines among
third party payers when reviewing treatment plans and progress reports. There is general
need expressed by managed mental health groups for specific treatment criteria to which
they can hold clinicians in determining whether they are going to provide payment for a
course of treatment.
Myriad issues are associated with the desirability of treatment guidelines, and
there are good reasons why many professional associations have not published treatment
guidelines. However, the financial realities of the current treatment environment make
the use of treatment guideline at least useful.
Organization of the Treatment Guidelines
The guidelines are organized into a single volume available in paperback. The volume
contains the not only the treatment guidelines but a chapter dealing with important
considerations in conducting a psychiatric/psychological evaluation. The sections of this
chapter include guidance on formulating the referral question to be answered in the
evaluation. Another section deals with the influence of the clinical setting of the
evaluation interview. The chapter then deals with the domains of the clinical evaluation
and finally the process of evaluation.
The chapters are composed with the treatment imperatives of each disorder taking
precedence over organization uniformity. The first three section of each treatment
guideline begins with:

A summary of recommendations

A disease definition, epidemiology, and natural history

Treatment principles and alternatives

The formulation and implementation of a treatment plan

Clinical features influencing treatment

A listing of the reviewers and reviewing organizations

A reference list
The essential content of the chapters remains as in previous editions of the
treatment guidelines with elaboration of specific treatment regimens, specifically I the
guideline for the treatment of HIV/AIDS.
Example of a Treatment Guideline: “Treatment guidelines for the treatment of patients
With HIV/AIDS”

The guideline is presented in two parts
o
Part A: Background Information and Treatment Recommendations for
Patients With HIV/AIDS
o Part B: Review and Synthesis of Available Evidence
Part A includes the summary of treatment recommendations, disease definition,
epidemiology and natural history, the formulation and implementation of the treatment
plan, and the clinical and environmental features influencing treatment. Part B reviews
the data regarding the prevention for individuals at high risk for HIV infection and data
regarding the psychiatric treatments for individuals with HIV infection.
Psychotherapy is given equal footing with pharmacotherapy interventions and the
emphasis on the “total person” and his or her living environment is enough to warm the
heart of any clinical social worker.
The Quick Reference to the American Psychiatric Association Practice Guidelines
for the Treatment of Psychiatric Disorders Compendium 2002 was published to meet the
needs of the practicing professional. Although this writer did not measure the volume, it
appears to be just about the size of the waist pocket of the white physician’s coat. The
quick reference “cuts to the chase” the ten disorders considered. The 10 quick reference
guides (QRGs) are condensed, but complete versions of the original treatment guidelines
found in the large volume. The obvious challenge was to write the QRGs in enough detail
to be useful but brief enough to be truly portable. The organization of the QRGs is in 4
sections, including diagnosis and assessment, and treatment recommendations vary
according to the evidence-based treatment indicated. This is what Norcross and
Prochaska among others have called prescriptive eclecticism, (Norcross & Prochaska,
1988). The heavy emphasis on sequence of treatment and pharmacotherapy make the
quick reference less useful to the non-physician clinician. It should be kept in mind that
the quick reference was written for the practicing psychiatrist and the logic and process is
geared to those professions treatment concepts.
References and Readings
American Psychiatric Association (2002). Practice guidelines for the treatment of
psychiatric disorders: compendium 2002. Arlington, VA: American Psychiatric
Press
American Psychiatric Association (2002). Quick reference to the American Psychiatric
Associations practice guidelines for the treatment of psychiatric disorders:
compendium 2002. Arlington, VA: American Psychiatric Press
Norcross, J. C., & Prochaska, J. O. (1988). A study of eclectic (and integrative) views
revisited. Professional Psychology: Research & Practice, 19, 170–174.