Clinical practice guidelines for bipolar disorder from the Department of Veterans Affairs

Background: For the last several years, the Department of Veterans Affairs (VA) has been involved in the development of practice guidelines for major medical, surgical, and mental disorders. This article describes the develop ment and content of the VA-Clinical Practice Guidelines for Bipolar Disorde r, which are available in their entirety on the Journal Web site (http://ww w. psychiatrist.com). Method: A multidisciplinary work group composed of content experts in the f ield of bipolar disorder and practitioners in general clinical practice was convened by the VA's Office of Performance and Quality and the Mental Heal th Strategic Health Group. The work group was instructed in algorithm devel opment and methods of evidence evaluation. Draft guidelines were developed over the course of 6 months of meetings and conference calls, and that draf t was then sent to nationally prominent content experts for final critique. Results: The Bipolar Guidelines are part of the family of the VA Clinical G uidelines for Management of Persons with Psychosis and consist of explicit algorithms supplemented by annotations that explain the specific decision p oints and their basis in the scientific literature. The guidelines are orga nized into 5 modules: a Core Module for diagnosis and assignment to mood st ate plus 4 treatment modules (Manic/Hypomanic/Mixed Episode, Bipolar Depres sive Episode, Rapid Cycling, and Bipolar Disorder With Psychotic Features). The modules specify particular diagnostic and treatment tasks at each step , including both somatotherapeutic and psychotherapeutic interventions. Conclusion: The VA Bipolar Guidelines are designed for easy clinical refere nce in decision making with individual patients, as well as for use as a sc holarly reference tool. They also have utility in training activities and q uality improvement programs.