Texas Medication Algorithm Project, phase 3 (TMAP-3): clinical results for patients with a history of mania.
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.
Suppes
Trisha
T
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, 75390-9070, USA. trisha.suppes@utsouthwestern.edu
Rush
A John
AJ
Dennehy
Ellen B
EB
Crismon
M Lynn
ML
Kashner
T Michael
TM
Toprac
Marcia G
MG
Carmody
Thomas J
TJ
Brown
E Sherwood
ES
Biggs
Melanie M
MM
Shores-Wilson
Kathy
K
Witte
Bradley P
BP
Trivedi
Madhukar H
MH
Miller
Alexander L
AL
Altshuler
Kenneth Z
KZ
Shon
Steven P
SP
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
D011619:Psychotropic Drugs