TY - JOUR
T1 - A feasibility study of the childhood depression medication algorithm
T2 - The Texas Children's Medication Algorithm Project (CMAP)
AU - Emslie, Graham J.
AU - Hughes, Carroll W.
AU - Crismon, M. Lynn
AU - Lopez, Molly
AU - Pliszka, Steve
AU - Toprac, Marcia G.
AU - Boemer, Christine
N1 - Funding Information:
The research was made possible by grants from the Meadows Foundation, the Hogg Foundation for Mental Health, and the Houston Endowment. The authors thank those physicians and health care staff who worked in the clinics that conducted this study—specifically W. Sepulveda, M.D., A. Mao, M.D., D. Hinkle, M.D., and K. Johnson, B.A., from MHMR Harris County Houston; R. Mallett, M.D., N. Ngyuen, M.D., V. Tutson, M.D., and D. Stokes, B.A., from Gulf Coast MHMR Center in League City; L. Rhodes, M.D., M. Dobson, M.D., J. Brenz, M.D., and L. Solorzano, M.S., from Center for MH Services San Antonio; and W. Porcher, M.D., and R. Black, M.S.W., from Blue Bonnet Trails MHMR Center in Round Rock.
PY - 2004/5
Y1 - 2004/5
N2 - Objective: To evaluate the feasibility and impact on clinical response and function associated with the use of an algorithm-driven disease management program (ALGO) for children and adolescents treated for depression with or without attention-deficit/hyperactivity disorder (ADHD) in community mental health centers. Method: Interventions included (1) medication algorithms, (2) clinical and technical support for the physician, (3) uniform chart documentation of outcomes, and (4) a patient/family psychoeducation program. Children eligible for entry into the study were referred to the child psychiatrist for initiation or change in medicine. Outcomes of treatment with the ALGO for up to 4 months are presented. Measures of change included clinical symptoms, functioning, and global improvement (Clinical Global Impression Scale). A historical chart cohort from the same clinics was used as a quasi-control. Results: Thirty-nine individuals (depression = 24; comorbid depression with ADHD = 15) were enrolled for treatment with ALGO. One hundred fourteen children were in the control cohort (74 depressed, 40 comorbid). For the ALGO groups, Children's Depression Rating Scale-Revised depression severity scores decreased from 48.2 to 32.5 and Child Adolescent Functioning Assessment Scale function scores improved from 70.3 to 40.9 (all p ≤ .0005). Clinical Global Impression Scale severity scores decreased from 5.7 to 3.7 in ALGO compared to only 5.8 to 4.8 in the control (p < .003). Conclusions: There was clear improvement in clinical symptoms, functioning, and global response with ALGO treatment. The magnitude of the improvement was greater in children and adolescents treated with the ALGO program compared with a historical cohort. These data support the need for controlled studies in larger populations examining the effects of algorithm-driven disease management programs on the clinical outcomes of children with mental illness.
AB - Objective: To evaluate the feasibility and impact on clinical response and function associated with the use of an algorithm-driven disease management program (ALGO) for children and adolescents treated for depression with or without attention-deficit/hyperactivity disorder (ADHD) in community mental health centers. Method: Interventions included (1) medication algorithms, (2) clinical and technical support for the physician, (3) uniform chart documentation of outcomes, and (4) a patient/family psychoeducation program. Children eligible for entry into the study were referred to the child psychiatrist for initiation or change in medicine. Outcomes of treatment with the ALGO for up to 4 months are presented. Measures of change included clinical symptoms, functioning, and global improvement (Clinical Global Impression Scale). A historical chart cohort from the same clinics was used as a quasi-control. Results: Thirty-nine individuals (depression = 24; comorbid depression with ADHD = 15) were enrolled for treatment with ALGO. One hundred fourteen children were in the control cohort (74 depressed, 40 comorbid). For the ALGO groups, Children's Depression Rating Scale-Revised depression severity scores decreased from 48.2 to 32.5 and Child Adolescent Functioning Assessment Scale function scores improved from 70.3 to 40.9 (all p ≤ .0005). Clinical Global Impression Scale severity scores decreased from 5.7 to 3.7 in ALGO compared to only 5.8 to 4.8 in the control (p < .003). Conclusions: There was clear improvement in clinical symptoms, functioning, and global response with ALGO treatment. The magnitude of the improvement was greater in children and adolescents treated with the ALGO program compared with a historical cohort. These data support the need for controlled studies in larger populations examining the effects of algorithm-driven disease management programs on the clinical outcomes of children with mental illness.
KW - Child and adolescent depression
KW - Childhood disorders
KW - Childhood psychopharmacology
KW - Comorbid attention deficit/hyperactivity disorder and major depressive disorder
KW - Medication algorithm
UR - http://www.scopus.com/inward/record.url?scp=2642517153&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=2642517153&partnerID=8YFLogxK
U2 - 10.1097/00004583-200405000-00005
DO - 10.1097/00004583-200405000-00005
M3 - Article
C2 - 15100558
AN - SCOPUS:2642517153
SN - 0890-8567
VL - 43
SP - 519
EP - 527
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 5
ER -