Texas Medication Algorithm Project: development and feasibility testing of a treatment algorithm for patients with...

Area of Science:

• Psychiatry
• Public Health
• Clinical Guidelines

Background:

• Treatment guidelines for major psychiatric illnesses have gained prominence.
• The Texas Medication Algorithm Project (TMAP) aimed to assess guideline development and implementation for bipolar disorder, major depressive disorder, and schizophrenia within Texas's public mental health system.
• This study details the consensus process for the Bipolar Disorder Module (Phase 1) and a feasibility trial (Phase 2) in Texas psychiatric settings.

Purpose of the Study:

• To evaluate the feasibility and process of developing and implementing treatment guidelines for bipolar disorder in a public mental health system.
• To test the implementation of the TMAP bipolar disorder algorithms in inpatient and outpatient settings.

Main Methods:

• Development of TMAP algorithms for bipolar disorder through a consensus process (Phase 1).
• A feasibility trial involving 69 patients treated with the Phase 1 algorithms in Texas psychiatric settings (Phase 2).

Main Results:

• Physicians accepted the treatment guidelines and adhered to recommended patient follow-up intervals.
• Sequenced treatment steps were utilized differentially throughout patient care.
• Observed improvements in clinical symptoms (using the 24-item Brief Psychiatric Rating Scale) were noted, though limited by the absence of a control group and use of volunteer physicians for ratings.

Conclusions:

• Developing and implementing treatment guidelines for patients with a history of mania in Texas public mental health clinics is achievable.
• TMAP Phase 3, a larger controlled trial, builds upon this methodology by assessing clinical and economic impacts and incorporating patient/family education.