Texas Medication Algorithm Project: Development and Feasibility Testing of a Treatment Algorithm for Patients With Bipolar Disorder
J Clin Psychiatry 2001;62(6):439-447
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Background: Use of treatment guidelines for
treatment of major psychiatric illnesses has increased in recent
years. The Texas Medication Algorithm Project (TMAP) was
developed to study the feasibility and process of developing and
implementing guidelines for bipolar disorder, major depressive
disorder, and schizophrenia in the public mental health system of
Texas. This article describes the consensus process used to
develop the first set of TMAP algorithms for the Bipolar Disorder
Module (Phase 1) and the trial testing the feasibility of their
implementation in inpatient and outpatient psychiatric settings
across Texas (Phase 2).
Method: The feasibility trial answered core
questions regarding implementation of treatment guidelines for
bipolar disorder. A total of 69 patients were treated with the
original algorithms for bipolar disorder developed in Phase 1 of
Results: Results support that physicians
accepted the guidelines, followed recommendations to see patients
at certain intervals, and utilized sequenced treatment steps
differentially over the course of treatment. While improvements
in clinical symptoms (24-item Brief Psychiatric Rating Scale)
were observed over the course of enrollment in the trial, these
conclusions are limited by the fact that physician volunteers
were utilized for both treatment and ratings, and there was no
Conclusion: Results from Phases 1 and 2 indicate
that it is possible to develop and implement a treatment
guideline for patients with a history of mania in public mental
health clinics in Texas. TMAP Phase 3, a recently completed
larger and controlled trial assessing the clinical and economic
impact of treatment guidelines and patient and family education
in the public mental health system of Texas, improves upon this