Report of the Texas Consensus Conference Panel on medication treatment of bipolar disorder 2000.
BACKGROUND
The process and outcome of a consensus conference to develop revised algorithms for treatment of bipolar disorder to be implemented in the public mental health system of Texas are described. These medication algorithms for bipolar disorder are an update of those developed for the Texas Medication Algorithm Project, a research study that tested the clinical and economic impact of treatment guidelines for major psychiatric illnesses treated in the Texas public mental health system (Texas Department of Mental Health and Mental Retardation [TDMHMR]).


METHODS
Academic clinicians and researchers, practicing clinicians in the TDMHMR system, administrators, advocates, and consumers participated in a consensus conference in August 2000. Participants attended presentations reviewing new evidence in the pharmacologic treatment of bipolar disorder and discussed the needs of consumers in the TDMHMR system. Principles were enumerated, including balancing of evidence for efficacy, tolerability, and safety in medication choices. A set of 7 distinct algorithms was drafted. In the following months, a subcommittee condensed this product into 2 primary algorithms.


RESULTS
The panel agreed to 2 primary algorithms: treatment of mania/hypomania, including 3 pathways for treatment of euphoric symptoms, mixed or dysphoric symptoms, and psychotic symptoms; and treatment of depressive symptoms. General principles to guide algorithm implementation were discussed and drafted.


CONCLUSIONS
The revised algorithms are currently being disseminated and implemented within the Texas public mental health system. The goals of the Texas initiative include increasing the consistency of appropriate treatment of bipolar disorder, encouraging systematic and optimal use of available pharmacotherapies, and improving the outcomes of patients with bipolar disorder.
Suppes
Trisha
T
Department of Psychiatry The University of Texas Southwestern Medical Center Dallas, 75390-9070, USA. patricia.suppes@utsouthwestern.edu
Dennehy
Ellen B
EB
Swann
Alan C
AC
Bowden
Charles L
CL
Calabrese
Joseph R
JR
Hirschfeld
Robert M A
RM
Keck
Paul E
PE
Sachs
Gary S
GS
Crismon
M Lynn
ML
Toprac
Marcia G
MG
Shon
Steven P
SP
D000465:Algorithms; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000517:prevention & control; D003663:Decision Trees; D003866:Depressive Disorder / Q000188:drug therapy / Q000517:prevention & control; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D008605:Mental Health Services / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use; D013781:Texas
D011619:Psychotropic Drugs