Preamble: Clinical Practice Guidelines- Indian Psychiatric Society

The Indian Psychiatric Society (IPS) continues its commitment to advancing clinical practice through evidence-based guidelines tailored to the Indian context. These guidelines aim to provide evidence-based, locally relevant recommendations to enhance clinical care, considering the unique sociocultural, economic, and healthcare contexts of the country. Over the years, IPS has published CPGs on a wide range of topics, including schizophrenia, depression, bipolar disorders, child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry, psychotherapies, psychiatric emergencies, brain stimulation techniques, and more. These have been well-received, offering practical guidance, while incorporating feedback from practicing psychiatrists to ensure applicability and updates as needed. DEVELOPMENT PROCESS In continuation of this effort, the IPS CPG Committee for 2025 has focused on updating and formulating guidelines for four major psychiatric disorders: schizophrenia, bipolar affective disorder, depression, and obsessive-compulsive disorder. These disorders represent a significant burden on mental health in India, affecting millions and often requiring tailored approaches due to cultural factors, resource limitations, and evolving evidence. To develop these CPGs, key topics were selected based on clinical relevance and emerging needs. Lead authors and experts from across India were identified for each guideline. Drafts were prepared by the lead authors and their co-authors. The drafts were discussed via e-mail exchanges, as well as in a series of virtual meetings held throughout 2025, involving experts from various zones and states. Feedback was incorporated to refine the drafts and final modifications made accordingly. SCOPE AND APPLICATION These guidelines address critical aspects of assessment, diagnosis, management, and follow-up for each disorder. For schizophrenia, emphasis is placed on early intervention, pharmacological and psychosocial treatments, psychoeducation, and rehabilitation. The bipolar affective disorder guideline covers mood stabilization, prevention of relapses, and management of mixed episodes, psychoeducation, and handling comorbidities. For depression, recommendations include stepped-care approaches, integration of psychotherapy, handling treatment-resistant cases, and suicide risk management. The obsessive-compulsive disorder guideline focuses on pharmacotherapy, cognitive-behavioral therapy, addressing comorbidities and stepped care for refractory cases. Overall, the guidelines incorporate the latest global evidence, while adapting to Indian realities, such as access to medications, family involvement, and stigma reduction. The formulation of these CPGs considered feasibility in diverse settings, from urban tertiary centers to rural community care and patients receiving treatments at both public and private sectors. They emphasize flexible application, considering patient socio-cultural milieu, past treatment history, and risk factors. Clinicians must exercise judgment, as these are not substitutes for individual clinical decision-making. Additionally, these guidelines are not intended as rigid protocols or substitutes for legal statutes, professional ethics, or individual clinical judgment. Clinicians should apply these recommendations critically, adapting them to the specific needs of patients, caregivers, and local resources, while staying updated with new research and best practices. We hope these guidelines will empower psychiatrists to deliver high-quality, evidence-informed care for these prevalent disorders, ultimately improving outcomes, and quality of life for affected individuals and their families. FUTURE DIRECTIONS IPS and authors of the CPGs acknowledges the dynamic nature of psychiatry, with ongoing updates planned as new evidence emerges. These guidelines aim to standardize care, promote better outcomes, and support psychiatrists in diverse clinical settings. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.