Biomedical subjects

Melanie M Biggs

Publications and source records attributed to Melanie M Biggs.

5 recordsLinked to original sources

PubMed2003

Clinician ratings vs. global ratings of symptom severity: a comparison of symptom measures in the bipolar disorder module, phase II, Texas Medication Algorithm Project.

This study compares ratings obtained with an itemized, clinician-rated, symptom severity measure--the 24-item Brief Psychiatric Rating Scale (BPRS(24))--to a Physician Global Rating Scale (PhGRS), a Patient Global Rating Scale (PtGRS) and the clinician-completed Multnomah Community Ability Scale (MCAS) in patients with bipolar disorder (BPD). A total of 69 patients (25 inpatients and 44 outpatients) with BPD were enrolled in a feasibility study of the use of medication algorithms in the treatment of BPD. Clinicians at each visit completed the BPRS(24), PhGRS and MCAS, and patients completed the PtGRS. Analyses compared the BPRS(24) and BPRS subscales with the PtGRS, PhGRS and MCAS. PtGRS scores correlated poorly with BPRS(24) and with PhGRS scores at baseline, although PtGRS change scores correlated moderately with BPRS(24) change scores. Baseline BPRS(24) and PhGRS scores correlated moderately at baseline with somewhat stronger correlations found on change scores for the two measures. MCAS scores showed moderate correlations with BPRS(24) scores both at baseline and with change over time. Global assessments by patients or physicians only moderately or poorly reflected BPRS(24) scores. Itemized symptom measures to gauge severity of illness or change over time are preferred over patient or physician global judgments.

Adult↗

PubMed2003

Impact of structured clinical interviews on physicians' practices in community mental health settings.

OBJECTIVE: Budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations. This study examined physicians' diagnosing and prescribing practices in the context of feedback from nurse-administered, structured clinical interviews of psychiatric patients in publicly funded outpatient mental health settings. METHODS: A randomized controlled trial was conducted of newly enrolled adult psychiatric patients who made at least one return visit for care at two county-supported outpatient clinics. Within two weeks after their intake psychiatric evaluation, patients were randomly assigned to receive a nurse-administered Structured Clinical Interview for DSM-IV-Clinician Version (SCID) (N=158) or to a control condition (N=138). The attending psychiatrist was provided with the SCID results. Abstracts from clinical records were used to measure differences in physicians' rates of ordering additional diagnostic evaluations, changing diagnoses, and changing types and dosages of medications at three- and six-month follow-ups. RESULTS: Physicians treating patients who received SCIDs, compared with control patients, were more likely to order evaluative procedures, update and change diagnosis (consistent with SCID results), and change prescription medication type and were less likely to increase patients' medication dosages. CONCLUSION: Nurse-administered structured clinical interviews are feasible and effectively help psychiatrists in publicly supported mental health clinics reach more accurate diagnoses for newly enrolled patients.

Adolescent↗

PubMed2003

Texas Medication Algorithm Project, phase 3 (TMAP-3): rationale and study design.

BACKGROUND: Medication treatment algorithms may improve clinical outcomes, uniformity of treatment, quality of care, and efficiency. However, such benefits have never been evaluated for patients with severe, persistent mental illnesses. This study compared clinical and economic outcomes of an algorithm-driven disease management program (ALGO) with treatment-as-usual (TAU) for adults with DSM-IV schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD) treated in public mental health outpatient clinics in Texas. DISCUSSION: The disorder-specific intervention ALGO included a consensually derived and feasibility-tested medication algorithm, a patient/family educational program, ongoing physician training and consultation, a uniform medical documentation system with routine assessment of symptoms and side effects at each clinic visit to guide ALGO implementation, and prompting by on-site clinical coordinators. A total of 19 clinics from 7 local authorities were matched by authority and urban status, such that 4 clinics each offered ALGO for only 1 disorder (SCZ, BD, or MDD). The remaining 7 TAU clinics offered no ALGO and thus served as controls (TAUnonALGO). To determine if ALGO for one disorder impacted care for another disorder within the same clinic ("culture effect"), additional TAU subjects were selected from 4 of the ALGO clinics offering ALGO for another disorder (TAUinALGO). Patient entry occurred over 13 months, beginning March 1998 and concluding with the final active patient visit in April 2000. Research outcomes assessed at baseline and periodically for at least 1 year included (1) symptoms, (2) functioning, (3) cognitive functioning (for SCZ), (4) medication side effects, (5) patient satisfaction, (6) physician satisfaction, (7) quality of life, (8) frequency of contacts with criminal justice and state welfare system, (9) mental health and medical service utilization and cost, and (10) alcohol and substance abuse and supplemental substance use information. Analyses were based on hierarchical linear models designed to test for initial changes and growth in differences between ALGO and TAU patients over time in this matched clinic design.

Adolescent↗

PubMed2003

Texas Medication Algorithm Project, phase 3 (TMAP-3): clinical results for patients with a history of mania.

BACKGROUND: The Texas Medication Algorithm Project (TMAP) assessed the clinical and economic impact of algorithm-driven treatment (ALGO) as compared with treatment-as-usual (TAU) in patients served in public mental health centers. This report presents clinical outcomes in patients with a history of mania (BD), including bipolar I and schizoaffective disorder, bipolar type, during 12 months of treatment beginning March 1998 and ending with the final active patient visit in April 2000. METHOD: Patients were diagnosed with bipolar I disorder or schizoaffective disorder, bipolar type, according to DSM-IV criteria. ALGO was comprised of a medication algorithm and manual to guide treatment decisions. Physicians and clinical coordinators received training and expert consultation throughout the project. ALGO also provided a disorder-specific patient and family education package. TAU clinics had no exposure to the medication algorithms. Quarterly outcome evaluations were obtained by independent raters. Hierarchical linear modeling, based on a declining effects model, was used to assess clinical outcome of ALGO versus TAU. RESULTS: ALGO and TAU patients showed significant initial decreases in symptoms (p =.03 and p <.001, respectively) measured by the 24-item Brief Psychiatric Rating Scale (BPRS-24) at the 3-month assessment interval, with significantly greater effects for the ALGO group. Limited catch-up by TAU was observed over the remaining 3 quarters. Differences were also observed in measures of mania and psychosis but not in depression, side-effect burden, or functioning. CONCLUSION: For patients with a history of mania, relative to TAU, the ALGO intervention package was associated with greater initial and sustained improvement on the primary clinical outcome measure, the BPRS-24, and the secondary outcome measure, the Clinician-Administered Rating Scale for Mania (CARS-M). Further research is planned to clarify which elements of the ALGO package contributed to this between-group difference.

Adolescent↗

PubMed2002

Itemized clinician ratings versus global ratings of symptom severity in patients with schizophrenia.

This study compares ratings obtained with an itemized clinician-rated symptom severity measure--the 24-item Brief Psychiatric Rating Scale (BPRS24)--with a Physician Global Rating Scale (PhGRS) and a Patient Global Rating Scale (PtGRS) in assessing treatment outcomes in patients with schizophrenia (SCZ). A total of 91 patients (31 inpatients and 60 outpatients) with SCZ were enrolled in a feasibility study of the use of medication algorithms in the treatment of SCZ. Clinicians completed the BPRS24 and the PhGRS; patients completed the PtGRS at each visit. The analyses reported here were conducted using the original BPRS18 and four items from the BPRS18 that rate the positive symptoms of psychosis (the Positive Symptom Rating Scale or PSRS), comparing anchored with global rating scales and with one another. The PtGRS had the lowest effect size (0.8) and was negatively correlated with the other ratings in inpatients. The PhGRS was significantly correlated (0.46) with the BPRS18, but the same person completed both ratings. The effect size of the PhGRS (0.6) was generally lower than with the BPRS18 (1.4) in differentiating responders from non-responders. On average, the PSRS had a slightly lower effect size than the longer itemized BPRS18, but the results support its use as a quantitative rating in circumstances where it is not feasible to routinely use a lengthier scale.

Adolescent↗