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

Trisha Suppes, A. John Rush, Ellen B. Dennehy, M. Lynn Crismon, T. Michael Kashner, Marcia G. Toprac, Thomas J. Carmody, E. Sherwood Brown, Melanie M. Biggs, Kathy Shores-Wilson, Bradley P. Witte, Madhukar H. Trivedi, Alexander L. Miller, Kenneth Z. Altshuler, Steven P. Shon

Research output: Contribution to journalArticlepeer-review

89 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)370-382
Number of pages13
JournalJournal of Clinical Psychiatry
Volume64
Issue number4
DOIs
StatePublished - Apr 1 2003

ASJC Scopus subject areas

  • Psychiatry and Mental health

Fingerprint Dive into the research topics of 'Texas Medication Algorithm Project, phase 3 (TMAP-3): Clinical results for patients with a history of mania'. Together they form a unique fingerprint.

Cite this