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.

METHOD:

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.

CONCLUSION:

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: Trisha Suppes, A John Rush, Ellen B Dennehy, M Lynn Crismon, T Michael Kashner, Marcia G Toprac, Thomas J Carmody, E Sherwood Brown, Melanie M Biggs, Kathy Shores-Wilson, Bradley P Witte, Madhukar H Trivedi, Alexander L Miller, Kenneth Z Altshuler, Steven P Shon, Texas Medication Algorithm Project
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 64 Issue 4 Pg. 370-82 (Apr 2003) ISSN: 0160-6689 [Print] United States
• PMID: 12716236 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Psychotropic Drugs

Topics

• Adolescent
• Adult
• Aged
• Algorithms
• Bipolar Disorder (diagnosis, drug therapy, economics)
• Community Mental Health Centers (economics, statistics & numerical data)
• Female
• Health Care Costs
• Health Services Research (methods)
• Humans
• Male
• Middle Aged
• Practice Guidelines as Topic
• Psychotic Disorders (diagnosis, drug therapy, economics)
• Psychotropic Drugs (economics, therapeutic use)
• Texas
• Treatment Outcome