Texas Medication Algorithm Project: development and feasibility testing of a treatment algorithm for patients with bipolar disorder.
BACKGROUND
Use of treatment guidelines for treatment of major psychiatric illnesses has increased in recent years. The Texas Medication Algorithm Project (TMAP) was developed to study the feasibility and process of developing and implementing guidelines for bipolar disorder, major depressive disorder, and schizophrenia in the public mental health system of Texas. This article describes the consensus process used to develop the first set of TMAP algorithms for the Bipolar Disorder Module (Phase 1) and the trial testing the feasibility of their implementation in inpatient and outpatient psychiatric settings across Texas (Phase 2).


METHODS
The feasibility trial answered core questions regarding implementation of treatment guidelines for bipolar disorder. A total of 69 patients were treated with the original algorithms for bipolar disorder developed in Phase 1 of TMAP.


RESULTS
Results support that physicians accepted the guidelines, followed recommendations to see patients at certain intervals, and utilized sequenced treatment steps differentially over the course of treatment. While improvements in clinical symptoms (24-item Brief Psychiatric Rating Scale) were observed over the course of enrollment in the trial, these conclusions are limited by the fact that physician volunteers were utilized for both treatment and ratings. and there was no control group.


CONCLUSIONS
Results from Phases 1 and 2 indicate that it is possible to develop and implement a treatment guideline for patients with a history of mania in public mental health clinics in Texas. TMAP Phase 3, a recently completed larger and controlled trial assessing the clinical and economic impact of treatment guidelines and patient and family education in the public mental health system of Texas, improves upon this methodology.
Suppes
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Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75390-9070, USA. Patricia.Suppes@UTSouthwestern.edu
Swann
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Dennehy
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Habermacher
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Mason
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Crismon
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Toprac
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Rush
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Shon
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Altshuler
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000553:Ambulatory Care / Q000706:statistics & numerical data; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy*; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D003155:Community Mental Health Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D013781:Texas; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D001569:Benzodiazepines