TY - JOUR
T1 - Texas Medication Algorithm Project, phase 3 (TMAP-3)
T2 - Clinical results for patients with a history of mania
AU - Suppes, Trisha
AU - Rush, A. John
AU - Dennehy, Ellen B.
AU - Crismon, M. Lynn
AU - Kashner, T. Michael
AU - Toprac, Marcia G.
AU - Carmody, Thomas J.
AU - Brown, E. Sherwood
AU - Biggs, Melanie M.
AU - Shores-Wilson, Kathy
AU - Witte, Bradley P.
AU - Trivedi, Madhukar H.
AU - Miller, Alexander L.
AU - Altshuler, Kenneth Z.
AU - Shon, Steven P.
PY - 2003/4/1
Y1 - 2003/4/1
N2 - 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.
AB - 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.
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U2 - 10.4088/JCP.v64n0403
DO - 10.4088/JCP.v64n0403
M3 - Article
C2 - 12716236
AN - SCOPUS:0038034217
SN - 0160-6689
VL - 64
SP - 370
EP - 382
JO - Journal of Clinical Psychiatry
JF - Journal of Clinical Psychiatry
IS - 4
ER -