Medication treatment for the severely and persistently mentally ill: The Texas Medication Algorithm Project

This article provides an overview of the issues involved in developing, usi ng, and evaluating specific medication guidelines for patients with psychia tric disorders. The potential advantages and disadvantages, as well as the essential elements in the structure of algorithms, are illustrated by exper ience to date with the Texas Medication Algorithm Project, a public-academi c collaboration. Phase 1 entailed assembling research findings on the effic acy of medications for schizophrenic, bipolar, and major depressive disorde rs. This knowledge was evaluated for its quality and relevance, integrated with expert clinical judgment as well as input by practicing clinicians, fa mily advocates,and patients. Phase 1 (the design and development of the alg orithms) was followed by a feasibility test (Phase 2). Phase 3 is an ongoin g evaluation comparing the clinical and economic effects of using specific medication guidelines (algorithms) versus treatment as usual in public sect or patients with severe and persistent mental illnesses.