Texas Medication Algorithm Project, phase 3 (TMAP-3): clinical results for patients with a history of mania.

Conference Paper

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.

Full Text

Duke Authors

Cited Authors

  • Suppes, T; Rush, AJ; Dennehy, EB; Crismon, ML; Kashner, TM; Toprac, MG; Carmody, TJ; Brown, ES; Biggs, MM; Shores-Wilson, K; Witte, BP; Trivedi, MH; Miller, AL; Altshuler, KZ; Shon, SP; Texas Medication Algorithm Project,

Published Date

  • April 2003

Published In

Volume / Issue

  • 64 / 4

Start / End Page

  • 370 - 382

PubMed ID

  • 12716236

International Standard Serial Number (ISSN)

  • 0160-6689

Digital Object Identifier (DOI)

  • 10.4088/jcp.v64n0403

Conference Location

  • United States