title: Texas Medication Algorithm Project, phase 3 (TMAP-3): clinical results for patients with a history of mania.
abstract: BACKGROUND
  The Texas Medication Algorithm Project (TMAP) assessed the clinical and economic impact of algorithm-driven treatment (ALGO) as compared with treatment-as-usual (TAU) in patients served in public mental health centers. This report presents clinical outcomes in patients with a history of mania (BD), including bipolar I and schizoaffective disorder, bipolar type, during 12 months of treatment beginning March 1998 and ending with the final active patient visit in April 2000.
  
  
  METHODS
  Patients were diagnosed with bipolar I disorder or schizoaffective disorder, bipolar type, according to DSM-IV criteria. ALGO was comprised of a medication algorithm and manual to guide treatment decisions. Physicians and clinical coordinators received training and expert consultation throughout the project. ALGO also provided a disorder-specific patient and family education package. TAU clinics had no exposure to the medication algorithms. Quarterly outcome evaluations were obtained by independent raters. Hierarchical linear modeling, based on a declining effects model, was used to assess clinical outcome of ALGO versus TAU.
  
  
  RESULTS
  ALGO and TAU patients showed significant initial decreases in symptoms (p =.03 and p <.001, respectively) measured by the 24-item Brief Psychiatric Rating Scale (BPRS-24) at the 3-month assessment interval, with significantly greater effects for the ALGO group. Limited catch-up by TAU was observed over the remaining 3 quarters. Differences were also observed in measures of mania and psychosis but not in depression, side-effect burden, or functioning.
  
  
  CONCLUSIONS
  For patients with a history of mania, relative to TAU, the ALGO intervention package was associated with greater initial and sustained improvement on the primary clinical outcome measure, the BPRS-24, and the secondary outcome measure, the Clinician-Administered Rating Scale for Mania (CARS-M). Further research is planned to clarify which elements of the ALGO package contributed to this between-group difference.
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, 75390-9070, USA. trisha.suppes@utsouthwestern.edu
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Dennehy
authors.forename: M Lynn
authors.initials: ML
authors.lastname: Crismon
authors.forename: T Michael
authors.initials: TM
authors.lastname: Kashner
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Toprac
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Carmody
authors.forename: E Sherwood
authors.initials: ES
authors.lastname: Brown
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Biggs
authors.forename: Kathy
authors.initials: K
authors.lastname: Shores-Wilson
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Witte
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Miller
authors.forename: Kenneth Z
authors.initials: KZ
authors.lastname: Altshuler
authors.forename: Steven P
authors.initials: SP
authors.lastname: Shon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D003155:Community Mental Health Centers / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use*; D013781:Texas; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs