Texas Medication Algorithm Project: Development and Feasibility Testing of a Treatment Algorithm for Patients With Bipolar Disorder

Background: Use of treatment guidelines fortreatment of major psychiatric illnesses has increased in recentyears. The Texas Medication Algorithm Project (TMAP) wasdeveloped to study the feasibility and process of developing andimplementing guidelines for bipolar disorder, major depressivedisorder, and schizophrenia in the public mental health system ofTexas. This article describes the consensus process used todevelop the first set of TMAP algorithms for the Bipolar DisorderModule (Phase 1) and the trial testing the feasibility of theirimplementation in inpatient and outpatient psychiatric settingsacross Texas (Phase 2).

Method: The feasibility trial answered corequestions regarding implementation of treatment guidelines forbipolar disorder. A total of 69 patients were treated with theoriginal algorithms for bipolar disorder developed in Phase 1 ofTMAP.

Results: Results support that physiciansaccepted the guidelines, followed recommendations to see patientsat certain intervals, and utilized sequenced treatment stepsdifferentially over the course of treatment. While improvementsin clinical symptoms (24-item Brief Psychiatric Rating Scale)were observed over the course of enrollment in the trial, theseconclusions are limited by the fact that physician volunteerswere utilized for both treatment and ratings, and there was nocontrol group.

Conclusion: Results from Phases 1 and 2 indicatethat it is possible to develop and implement a treatmentguideline for patients with a history of mania in public mentalhealth clinics in Texas. TMAP Phase 3, a recently completedlarger and controlled trial assessing the clinical and economicimpact of treatment guidelines and patient and family educationin the public mental health system of Texas, improves upon thismethodology.