Texas Medication Algorithm Project, Phase 3 (TMAP-3): Clinical Results for Patients With a History of Mania
J Clin Psychiatry 2003;64(4):370-382
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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