The Texas Implementation of Medication Algorithms

Update to the algorithms for treatment of bipolar I disorder

Trisha Suppes, Ellen B. Dennehy, Robert M A Hirschfeld, Lori L. Altshuler, Charles L. Bowden, Joseph R. Calabrese, M. Lynn Crismon, Terence A. Ketter, Gary S. Sachs, Alan C. Swann

Research output: Contribution to journalArticle

301 Citations (Scopus)

Abstract

Background: A panel consisting of academic psychiatrists and pharmacist administrators of the Texas Department of State Health Services (formerly Texas Department of Mental Health and Mental Retardation), community mental health physicians, advocates, and consumers met in May 2004 to review new evidence in the pharmacologic treatment of bipolar I disorder (BDI). The goal of the consensus conference was to update and revise the current treatment algorithm for BDI as part of the Texas Implementation of Medication Algorithms, a statewide quality assurance program for the treatment of major psychiatric illness. The guidelines for evaluating possible medications, the criteria for selection and ranking, and the updated algorithms are described. Method: Principles from previous consensus conferences were reviewed and amended. Medication algorithms for the acute treatment of hypomanic/manic or mixed and depressive episodes in BDI were developed after examining recent efficacy and safety and tolerability data. Recommendations for maintenance treatments were developed. Results: The panel updated the 2 primary algorithms (hypomanic/manic/mixed and depressive) based on clinical evidence for efficacy, tolerability, and safety developed since 2000. Expert consensus was utilized where clinical evidence was limited. Prevention of new episodes or prophylaxis treatment recommendations were developed based on recent data from longer-term trials. Maintenance recommendations are provided as levels versus a specified staged algorithm, as for acute treatment, due to the relatively limited database to inform treatment. Conclusions: These algorithms for the treatment of BDI represent the recommendations based on the most recent evidence available. These recommendations are meant to provide a framework for clinical decision making, not to replace clinical judgment. As with any algorithm, treatment practices will evolve beyond the recommendations of this consensus conference as new evidence and additional medications become available.

Original languageEnglish (US)
Pages (from-to)870-886
Number of pages17
JournalJournal of Clinical Psychiatry
Volume66
Issue number7
StatePublished - Jul 2005

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Bipolar Disorder
Consensus
Therapeutics
Psychiatry
Mental Health
Safety
Administrative Personnel
Pharmacists
Intellectual Disability
Patient Selection
Health Services
Maintenance
Databases
Guidelines
Physicians

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Suppes, T., Dennehy, E. B., Hirschfeld, R. M. A., Altshuler, L. L., Bowden, C. L., Calabrese, J. R., ... Swann, A. C. (2005). The Texas Implementation of Medication Algorithms: Update to the algorithms for treatment of bipolar I disorder. Journal of Clinical Psychiatry, 66(7), 870-886.

The Texas Implementation of Medication Algorithms : Update to the algorithms for treatment of bipolar I disorder. / Suppes, Trisha; Dennehy, Ellen B.; Hirschfeld, Robert M A; Altshuler, Lori L.; Bowden, Charles L.; Calabrese, Joseph R.; Crismon, M. Lynn; Ketter, Terence A.; Sachs, Gary S.; Swann, Alan C.

In: Journal of Clinical Psychiatry, Vol. 66, No. 7, 07.2005, p. 870-886.

Research output: Contribution to journalArticle

Suppes, T, Dennehy, EB, Hirschfeld, RMA, Altshuler, LL, Bowden, CL, Calabrese, JR, Crismon, ML, Ketter, TA, Sachs, GS & Swann, AC 2005, 'The Texas Implementation of Medication Algorithms: Update to the algorithms for treatment of bipolar I disorder', Journal of Clinical Psychiatry, vol. 66, no. 7, pp. 870-886.
Suppes T, Dennehy EB, Hirschfeld RMA, Altshuler LL, Bowden CL, Calabrese JR et al. The Texas Implementation of Medication Algorithms: Update to the algorithms for treatment of bipolar I disorder. Journal of Clinical Psychiatry. 2005 Jul;66(7):870-886.
Suppes, Trisha ; Dennehy, Ellen B. ; Hirschfeld, Robert M A ; Altshuler, Lori L. ; Bowden, Charles L. ; Calabrese, Joseph R. ; Crismon, M. Lynn ; Ketter, Terence A. ; Sachs, Gary S. ; Swann, Alan C. / The Texas Implementation of Medication Algorithms : Update to the algorithms for treatment of bipolar I disorder. In: Journal of Clinical Psychiatry. 2005 ; Vol. 66, No. 7. pp. 870-886.
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