The Texas Medication Algorithm Project used a treatment algorithm to examine clinical outcomes such as clinical decision making, quality of care, consistent treatment plans, individualized treatment, and improvements in universal clinical documentation. The effect of this systematized treatment guideline and a patient/family education program was studied in patients with bipolar I disorder or schizoaffective disorder, bipolar type.

This open, controlled study divided 267 bipolar disorder subjects into two groups: One group (N=141) was treated using algorithm and evidenced-based consensus intervention; the second group (N=126) received the non-algorithm treatment. Comparisons were made to determine the effect of these approaches on psychiatric symptoms, depressive symptoms, manic symptoms, physical and mental function, and side effects.

Initial results from the algorithm group indicate significant positive initial effects on psychotic symptoms evaluated by BPRS and manic/ hypomanic symptoms evaluated by CARS-M; the manic/hypomanic symptoms did not show any catch-up over time. The non-algorithm group had a significant improvement over time; the catch-up was not significant. No significant differences were observed in the effect on depressive symptoms evaluated by IDS-C. Very depressed subjects responded better to algorithm-based treatment. There was no significant difference in physical and mental function between groups as evaluated by SF-12. Subjects treated using the algorithm had a significant positive initial effect on side effects as measured by SAFTEE.

Recently, the Texas state legislature mandated implementation in the public mental health system of treatment guidelines for serious mental illnesses. The goals of this initiative, referred to as the Texas Implementation of Medication Algorithms Project, include ensuring more uniform treatment of serious psychiatric illnesses. As a result, the algorithm was updated and revised by including more treatment options such as atypical antipsychotics and lamotrigine. More information about this algorithm is available at the web site: http://www.mhmr.state.tx.us/central office/medical director/tmap.html