Korean Medication Algorithm for Bipolar Disorder 2018 : Children and Adolescents / 우울ㆍ조울병

OBJECTIVES: The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2014: Children and Adolescents.METHODS: We performed the survey, using a questionnaire comprising 22 questions according to each situation, in children and adolescents with bipolar disorder.RESULTS: First-line pharmacotherapeutic strategies for manic episode in children with bipolar disorder were a combination of mood stabilizer (MS) and an atypical antipsychotics (AAP), monotherapy with an AAP, risperidone, and aripiprazole. Aripiprazole was selected as first-line medication for depressive episode in children with bipolar disorder, and aripiprazole, and risperidone were selected as first-line at high-risk children. First-line pharmacotherapeutic strategies for manic episode in adolescents were a combination of MS and an AAP, monotherapy with an AAP valproate, lithium, risperidone (Treatment of Choice, TOC), aripiprazole, and quetiapine. First-line pharmacotherapeutic strategies for depressive episode in adolescents, were a combination of an atypical antipsychotics and lamotrigine, valproate, aripiprazole (TOC), risperidone, and quetiapine. For depressive episodes in adolescents at high risk for bipolar disorder, valproate, aripiprazole (TOC), and risperidone were selected as first-line medication.CONCLUSION: We expect that the present KMAP-BP 2018-children and adolescents, is useful for clinicians to treat children and adolescents with bipolar disorder.

Korean Medication Algorithm for Bipolar Disorder 2018 : The Elderly / 우울ㆍ조울병

OBJECTIVES: The fourth revision of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was performed to provide more proper guidelines for clinicians. In this study, we evaluated treatment strategies of elderly patients with bipolar disorders of KMAP-BP 2018.METHODS: Sixty-one psychiatrists of the review committee with vast clinical experiences in treating bipolar disorders, completed the survey. An expert consensus was obtained, on pharmacological treatment strategies for elderly patients with bipolar disorder. The executive committee analyzed results, and discussed the results to produce the final algorithm.RESULTS: In elderly patients with bipolar disorder, first-line treatment option for acute manic episode is monotherapy, with atypical antipsychotics or mood stabilizer, and a combination of mood stabilizer and atypical antipsychotics. First-line treatment option for acute depressive episode, was a combination of mood stabilizer and atypical antipsychotics, monotherapy with atypical antipsychotic or mood stabilizer, and atypical antipsychotics with lamotrigine.CONCLUSION: In KMAP-BP 2018, the recommendation for treatment option in elderly patients with bipolar disorder, was newly introduced. We expect this algorithm may provide valuable information, and facilitate treatment of elderly patients with bipolar disorder.

Korean Medication Algorithm for Bipolar Disorder 2018 : Depressive Episode / 우울ㆍ조울병

OBJECTIVES: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the fourth revision of KMAP-BP was completed in 2018 in order to reflect the recent rapid research and development into bipolar disorder and psychopharmacology.METHODS: According to the methodology of previous versions, KMAP-BP 2018 was revised using a questionnaire consisting of 10 questions. Among eighty-four experts of the review committee, sixty-one completed the survey.RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer (MS) combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Switching or adding AAP, lamotrigine, or MS as 2nd strategies and clozapine or augmentation of buspirone, stimulant, or thyroid hormone as 3rd strategies were recommended. Compared to the previous KMAP-BP series, preference of AAP and lamotrigine has increased in the treatment of bipolar depressive episode in KMAP-BP 2018. Among the AAPs, olanzapine, quetiapine, and aripiprazole were preferred.CONCLUSION: Compared with the previous versions, we found that more active pharmacological strategies using AAP and lamotrigine as initial and next treatment strategies, respectively, were preferred, although few drugs were approved for bipolar depression.

Korean Medication Algorithm for Bipolar Disorder 2018 : Mixed Features / 우울ㆍ조울병

OBJECTIVES: The Korean Medication Algorithm for Bipolar Disorder 2018 (KMAP-BP 2018) has been revised again as a result of a consensus of opinions among experts. The mixed episode was changed to mixed features in DSM-5. In this study, we will describe the preference and recommendation of KMAP-BP 2018 for the treatment of mood episodes with mixed features.METHODS: Out of 84 members of the review committee, 61 completed the survey. We analyzed the answers, discussed the data, and held a clinician hearing.RESULTS: The preferred first-step strategies for mixed features with more manic symptoms were a combination of mood stabilizers (MS), atypical antipsychotics (AAP), and AAP monotherapy. For mixed features with more depressive symptoms, a combination of MS and lamotrigine (LTG), a combination of MS and AAP, and a combination of AAP and LTG were preferred. For mixed features with manic and depressive symptoms, a combination of MS and AAP, and AAP monotherapy were preferred.CONCLUSION: For mixed features, a combination of MS and AAP was generally preferred, and lamotrigine was preferred for depressive symptoms. We hope this KMAP-BP 2018 to be helpful for clinicians that treat patients with bipolar disorder in Korea.

Korean Medication Algorithm for Bipolar Disorder 2018 : Rapid Cycling / 우울ㆍ조울병

OBJECTIVES: The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder 2014 for rapid cycling.METHODS: The questionnaires, which were intended to survey experts for their opinions of medication used for rapid cycling, were completed by the review committee, which consisted of 84 Korean expert psychiatrists. We classified the responses into three categories. based on the lowest category in which the confidence interval fall (6.5≤ for first-line and 3.5≤ for high second-line treatment).RESULTS: The first-line treatment was the combination of a mood stabilizer and an atypical antipsychotic. This combination strategy was the treatment of choice for manic episodes. Additionally, a mood stabilizer with lamotrigine therapy and an atypical antipsychotic with lamotrigine combinations were the first-line treatments for the depressive phase. Atypical antipsychotic monotherapy, mood stabilizer monotherapy, the combination of two mood stabilizers, and the triple combination of mood stabilizers, atypical antipsychotics, and antidepressants were preferred as the next strategies. The first-line medications in all cases were valproate, quetiapine, olanzapine and aripiprazole. Lithium was the first-line medication in depressive and hypomanic episodes, and lamotrigine was the first-line medication for the treatment of the depressive phase.CONCLUSION: Compared to the surveys in 2014, the preference for atypical antipsychotics and lamotrigine have increased, and modalities used as a second-line treatment were more diverse.

Korean Medication Algorithm for Bipolar Disorder 2018 : Maintenance Therapy / 우울ㆍ조울병

OBJECTIVES: In this study, we evaluated the maintenance-treatment strategies of bipolar I and bipolar II disorders of KMAP-BP 2018.METHODS: The questionnaire used to survey experts for their opinions of medication used for the treatment of bipolar disorder was completed by the review committee consisting of 84 experienced psychiatrists. It is composed of 50 questions, and each question includes various sub-items. The questionnaire for maintenance treatments was composed of overall treatment strategies after acute mood episodes in bipolar I and II disorders, including the choice of antipsychotic and antidepressant drugs, duration of medication, and treatment strategies used to achieve a breakthrough in symptoms.RESULTS: In case of bipolar I disorder, mood stabilizer monotherapy, a combination of mood stabilizer and atypical antipsychotic drugs, and atypical antipsychotic drug monotherapy were the first-line treatments. In maintenance management for bipolar II disorder, combinations of mood stabilizer and mood stabilizer monotherapy or atypical antipsychotic monotherapy were preferred. Atypical antipsychotic drugs were favored as the maintenance treatment for bipolar I and II disorders in KMAP-BP 2018.CONCLUSION: There have been growing bodies of tendency that atypical antipsychotics are more preferred than previously in the KMAP-BP 2014.

Korean Medication Algorithm for Bipolar Disorder 2018: Overview / 우울ㆍ조울병

OBJECTIVES: The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP), which was first published in 2002 and updated in 2006, 2010 and 2014, is revised again through the expert's consensus of opinion.METHODS: Out of eighty-four member of the review committee, sixty-one members completed the survey. We analyzed the answers, and thus discussed the data and held a clinician hearing on the results. Therefore, we report the results of KMAP-BP 2018.RESULTS: The preferred first-step strategies for acute euphoric mania are the combination of mood stabilizer (MS) and atypical antipsychotics (AAP), MS monotherapy and AAP monotherapy. For psychotic mania, combination of MS and AAP, and AAP monotherapy are preferred. The first-step strategies for acute bipolar, mild to moderate, depression are MS monotherapy, lamotrigine (LTG) monotherapy, AAP monotherapy, MS+AAP combination, AAP+LTG combination and MS+LTG combination. For non-psychotic severe depression, the MS+AAP combination, AAP+LTG combination and MS+LTG combination are preferred. For psychotic severe depression, the MS+AAP, AAP+antidepressant (AD) and AAP+LTG are preferred.CONCLUSION: We surveyed the expert consensus for the treatment of bipolar disorders and developed KMAP-BP 2018. We hope that this KMAP-BP 2018 is going to be helpful for clinicians to treat the patients with bipolar disorder.

Korean Medication Algorithm for Bipolar Disorder 2018: Manic Episode / 우울ㆍ조울병

OBJECTIVES: We revised the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2014 to provide more timely information for the use of the information by clinicians.METHODS: We performed the survey using a questionnaire for the treatment of manic or hypomanic episode in the participants. There were sixty-one members of the review committee who completed the survey. The executive committee analyzed the results and discussed the final production of the applicable algorithm as considering the scientific evidence.RESULTS: The combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) was recommended as the treatment of choice (TOC), and a monotherapy with an AAP was the first-line pharmacotherapeutic strategy for the initial treatment of mania, with or without psychotic features. The MS monotherapy was the first-line choice therapy, but only for the non-psychotic mania patients. When the initial treatment failed, the TOC was a combination of a MS and an AAP in mania with or without psychotic features, and a combination of two AAPs was TOC for the psychotic mania, as well. For hypomania, the monotherapy with MS or AAP was the first-line as initial treatment, and the recommended switch to or add an AAP was recommended when the initial strategies failed.CONCLUSION: Compared with the previous version, the experts recommend more intensive interventions earlier when initial treatment failed to respond to a recommended monotherapy.