The Indian Psychiatric Society (IPS) has been constantly endeavoring to provide guidance to psychiatrists in India through the Clinical Practice Guidelines (CPGs). For close to two decades, the IPS has formulated several guidelines ranging in topics from schizophrenia, depression, bipolar disorders, sleep disorders, substance use disorders, child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry, psychotherapy, consultation-liaison psychiatry, and other topics. The guidelines have been developed through a consultative process involving experts from different parts of India and tempering the guidelines to the country’s resources and needs. Feedback from the practicing psychiatrists from the country has enabled to reflect upon the guidelines and make suitable modifications as necessary. Over time, the guidelines have become a repository of approaches and decisional directions for the clinical care of patients with mental health concerns and psychiatric illnesses.
The present set of CPGs focus on psychiatric emergencies and brain stimulation techniques. Psychiatrists often encounter referrals from emergencies for varied reasons. Additionally, brain stimulation techniques have seen phenomenal growth over the last few decades and are seeing incremental advances and diversifying applications. Thus, a need has been felt for CPGs to address these issues. Fifteen topics were identified related to psychiatric emergencies and brain stimulation techniques. The lead authors for these CPGs were chosen based on their contribution and expertise in particular areas. A task force meeting was organized at Jaipur on July 23 and 24, 2022, where the draft CPGs were presented, and feedback was sought from the participants that included experts from different zones and states. Based on the feedback, the CPGs were revised. The revised CPGs were put up on the IPS website in November 2022 for comments and suggestions from the members of IPS. Final changes in the CPGs were made based upon the final set of comments from the membership.
Most clinicians working in the field of psychiatry would have countered some or other psychiatric emergencies. Management of various psychiatric issues in emergency settings requires quick decision-making, proper diagnosis, and ensuring safety and early stabilization. Accordingly, in terms of psychiatric emergencies, CPGs in this edition focus on the assessment and management of suicidal behavior, violence and aggression, anxiety and panic disorders, dissociative disorders, breaking bad news, psychosocial crisis, psychiatric emergencies in victims of sexual offenses, and borderline personality disorder. Additionally, psychiatric emergencies in specific subgroups such as children/adolescents, the elderly, medical professionals, and those abusing various substances have also been addressed in separate CPGs.
Brain stimulation services across the country have expanded rapidly in recent times. Accordingly, this edition of CPGs addresses electroconvulsive therapy, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (TDCS).
The development process of the guidelines was inclusive of different approaches of development and recommending suggestions. The guideline development was cognizant of the unique socio-cultural characteristics of the country and the framework of service provision. There is diversity in the manner mental health care is practiced, as there are differences in the scale of operations, expertise and resources available, the mandate of public funding, and private enterprise. These guidelines have been formulated in such a way that these provide adequate framework for proper management, help to maintain relevant standard of care, emerging advances in the field of psychiatry and at the same time are flexible enough to be applicable in different contexts. We acknowledge that the medical field is ever-evolving and new evidence emerging may change the best practices. Thus, clinicians should use their critical judgment while applying the recommendations for a particular scenario, being cognizant of the unique circumstances of the setting, and the patient. It is important to understand that these guidelines are not a substitute for clinical judgment. We envision that the guidelines would contribute to better care of the patients presenting to the clinical setting.
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