Texas Medication Algorithm Project: Development and feasibility testing ofa treatment algorithm for patients with bipolar disorder

Background: Use of treatment guidelines for treatment of major psychiatric illnesses has increased in recent years. The Texas Medication Algorithm Pro ject (TMAP) was developed to study the feasibility and process of developin g and implementing guidelines for bipolar disorder, major depressive disord er, and schizophrenia in the public mental health system of Texas. This art icle describes the consensus process used to develop the first set of TMAP algorithms for the Bipolar Disorder Module (Phase 1) and the trial testing the feasibility of their implementation in inpatient and outpatient psychia tric settings across Texas (Phase 2). Method: The feasibility trial answered core questions regarding implementat ion of treatment guidelines for bipolar disorder. A total of 69 patients we re treated with the original algorithms for bipolar. disorder developed in Phase 1 of TMAP. Results: Results support that physicians accepted the guidelines, followed recommendations to see patients at certain intervals, and utilized sequence d treatment steps differentially over the course of treatment. While improv ements in clinical symptoms (24-item Brief Psychiatric Rating Scale) were o bserved over the course of enrollment in the trial, these conclusions are l imited by the fact that physician volunteers were utilized for both treatme nt and ratings, and there was no control group. Conclusion: Results from Phases 1 and 2 indicate that it is possible to dev elop and implement a treatment guideline for patients with a history of man ia in public mental health clinics in Texas. TMAP Phase 3, a recently compl eted larger and controlled trial assessing the clinical and economic impact of treatment guidelines and patient and family education in the public men tal health system of Texas, improves upon this methodology.