Clinical Practice Guidelines for Bipolar Disorder From the Department of Veterans Affairs

Background: For the last several years, theDepartment of Veterans Affairs (VA) has been involved in thedevelopment of practice guidelines for major medical, surgical, and mental disorders. This article describes the development and content of the VA-Clinical Practice Guidelines for Bipolar Disorder, which are available in their entirety on the Journal Web site (http://www. psychiatrist.com).

Method: A multidisciplinary work group composed of content experts in the field of bipolar disorder and practitioners in general clinical practice was convened by theVA’s Office of Performance and Quality and the Mental Health Strategic Health Group. The work group was instructed inalgorithm development and methods of evidence evaluation. Draft guidelines were developed over the course of 6 months of meetings and conference calls, and that draft was then sent to nationally prominent content experts for final critique.

Results: The Bipolar Guidelines are part of the family of the VA Clinical Guidelines for Management of Persons with Psychosis and consist of explicit algorithms supplemented byannotations that explain the specific decision points and their basis in the scientific literature. The guidelines are organized into 5 modules: a Core Module for diagnosis and assignment to mood state plus 4 treatment modules (Manic/Hypomanic/MixedEpisode, Bipolar Depressive Episode, Rapid Cycling, and BipolarDisorder With Psychotic Features). The modules specify particulardiagnostic and treatment tasks at each step, including bothsomatotherapeutic and psychotherapeutic interventions.

Conclusion: The VA Bipolar Guidelines aredesigned for easy clinical reference in decision making withindividual patients, as well as for use as a scholarly referencetool. They also have utility in training activities and quality improvement programs.