Medication treatment for the severely and persistently mentally ill: the Texas Medication Algorithm Project.
This article provides an overview of the issues involved in developing, using, and evaluating specific medication guidelines for patients with psychiatric disorders. The potential advantages and disadvantages, as well as the essential elements in the structure of algorithms, are illustrated by experience to date with the Texas Medication Algorithm Project, a public-academic collaboration. Phase 1 entailed assembling research findings on the efficacy of medications for schizophrenic, bipolar, and major depressive disorders. This knowledge was evaluated for its quality and relevance, integrated with expert clinical judgment as well as input by practicing clinicians, family advocates, and patients. Phase 1 (the design and development of the algorithms) was followed by a feasibility test (Phase 2). Phase 3 is an ongoing evaluation comparing the clinical and economic effects of using specific medication guidelines (algorithms) versus treatment as usual in public sector patients with severe and persistent mental illnesses.
Rush
A J
AJ
Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 75235-9086, USA.
Rago
W V
WV
Crismon
M L
ML
Toprac
M G
MG
Shon
S P
SP
Suppes
T
T
Miller
A L
AL
Trivedi
M H
MH
Swann
A C
AC
Biggs
M M
MM
Shores-Wilson
K
K
Kashner
T M
TM
Pigott
T
T
Chiles
J A
JA
Gilbert
D A
DA
Altshuler
K Z
KZ
D000465:Algorithms; D001714:Bipolar Disorder / Q000188:drug therapy; D002908:Chronic Disease; D002985:Clinical Protocols / Q000592:standards; D002986:Clinical Trials as Topic; D003245:Consensus Statements as Topic; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003866:Depressive Disorder / Q000188:drug therapy; D016527:Drug Costs; D005240:Feasibility Studies; D017048:Health Care Costs; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D010353:Patient Education as Topic / Q000379:methods; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use; D011788:Quality of Life; D012559:Schizophrenia / Q000188:drug therapy; D012720:Severity of Illness Index; D013781:Texas
D011619:Psychotropic Drugs