The Texas Medication Algorithm Project (TMAP) is a decision-tree
medical algorithm
A medical algorithm is any computation, formula, statistical survey, nomogram, or look-up table, useful in healthcare. Medical algorithms include decision tree approaches to healthcare treatment (e.g., if symptoms A, B, and C are evident, then ...
, the design of which was based on the expert opinions of mental health specialists. It has provided and rolled out a set of
psychiatric
Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental conditions. These include matters related to cognition, perceptions, mood, emotion, and behavior.
Initial psychiatric assessment of ...
management guidelines for doctors treating certain mental disorders within
Texas' publicly funded
mental health
Mental health is often mistakenly equated with the absence of mental illness. However, mental health refers to a person's overall emotional, psychological, and social well-being. It influences how individuals think, feel, and behave, and how t ...
care system, along with manuals relating to each of them The algorithms commence after diagnosis and cover pharmacological treatment (hence "Medication Algorithm").
History
TMAP was initiated in the fall of 1997 and the initial research covered around 500 patients.
TMAP arose from a collaboration that began in 1995 between the
Texas Department of Mental Health and Mental Retardation (TDMHMR),
pharmaceutical
Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the ...
companies, and the
University of Texas Southwestern. The research was supported by the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Meadows Foundation, the Lightner-Sams Foundation, the Nanny Hogan Boyd Charitable Trust, TDMHMR, the Center for Mental Health Services, the Department of Veterans Affairs, the Health Services Research and Development Research Career Scientist Award, the United States Pharmacopoeia Convention Inc. and Mental Health Connections.
Numerous companies that invent and develop antipsychotic medications provided use of their medications and furnished funding for the project. Companies did not participate in the production of the guidelines. However, in 2012 Dr. Stephen Shon, the medical director of Department of Mental Health and Mental Retardation (MHMR) and author of TMAP, admitted to receiving direct payment from the company
Janssen Phamaceuticals while leading the creation of TMAP. Under such influence, TMAP favored drugs sold by Jansen. For example, the widely used antipsychotic drug Haldol was replaced with the more expensive
Risperdal
Risperidone, sold under the brand name Risperdal among others, is an atypical antipsychotic used to treat schizophrenia and bipolar disorder, as well as aggressive and self-injurious behaviors associated with autism spectrum disorder. It is ta ...
for every potential Haldol user covered by Texas Medicaid. Resperdal cost 40 times more than Haldol, had worse side effects, and had a similar efficacy to Haldol.
In 2004, TMAP was mentioned as an example of a successful project in a paper regarding implementing mental health screening programs throughout the
United States
The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
, by President
George W. Bush's New Freedom Commission on Mental Health
The New Freedom Commission on Mental Health was established by U.S. President George W. Bush through on April 29, 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findin ...
, which looks to expand the program federally. The President had previously been Governor of Texas, in the period when TMAP was implemented. Similar programs have been implemented in about a dozen States, according to a 2004 report in the ''
British Medical Journal
''The BMJ'' is a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group Ltd, which in turn is wholly-owned by the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world ...
''.
Similar algorithms with similar prescribing advice have been produced elsewhere, for instance at the
Maudsley Hospital
The Maudsley Hospital is a British psychiatric hospital in south London. The Maudsley is the largest mental health training institution in the UK. It is part of South London and Maudsley NHS Foundation Trust, and works in partnership with the I ...
, London.
[{{cite web, url=http://www.mhc.com/Algorithms/AlgoLinks.HTML, title=Lists of Psychopharmacology Algorithms, first=David N., last=Osser, first2=Robert D., last2=Patterson, accessdate=March 17, 2006, website=Maudsley Hospital, url-status=unfit, archive-url=https://web.archive.org/web/20010626062649/http://www.mhc.com/Algorithms/AlgoLinks.HTML, date=May 1, 2001, archivedate=June 26, 2001]
References
External links
MentalHealthCommission.gov- President's New Freedom Commission on Mental Health (official US government website)
Health informatics
Treatment of mental disorders
Drugs in the United States
Mental disorders screening and assessment tools