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.

Can Residual Symptoms During Inter-Episode Period after Partial Remission in Bipolar I Disorder Have Cyclic Patterns with Specific Frequencies?

This case report aimed to describe cyclic patterns of residual mood symptoms in partially remitted bipolar I patient. In a 24-year-old woman with bipolar I disorder, residual mood symptoms measured by self-rated daily mood chart for 18 months were analyzed using wavelet analysis. A 146-day periodicity was prominent for the first 100 days after discharge. Between 100–200 days, 146-day periodicity was progressively diminished and 21- and 8-day periodicity was prominent. Between 200–516 days, 21-day periodicity was diminished and 85-day periodicity became prominent. This case suggest that bipolar patients might have cyclic residual symptoms with specific frequencies.

Korean Medication Algorithm for Bipolar Disorder 2006(IV): Rapid Cycling / 대한정신약물학회지

OBJECTIVE: The development of treatment guidelines has emerged as an important element so as to standardize treatment and to provide clinicians with algorithms. From the previous publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP): rapid cycling in 2002, we revised that in 2006. METHODS: The questionnaire to survey the expert opinion of medication for rapid cycling was completed by the review committee consisting of 53 experienced Korean psychiatrists. It is composed of 7 questions, and each question includes various options. We classified the expert opinion to 3 categories based on the lowest category in which the confidence interval fell (6.5 < or = for first-line and 3.5< or = for second-line treatment). RESULTS: Generally, 'treatment of choice' for rapid cycling was not demonstrated. The first-line treatment is the combination of a mood stabilizer and an atypical antipsychotic. Combination of two mood stabilizers was preferred as next strategy. Divalproex and lithium were the first-line choice as mood stabilizer. Compared to the surveys in 2002, the preference for lamotrigine and atypical antipsychotics has increased while that of carbamazepine and antidepressant has decreased. CONCLUSION: With the result of the survey, the discussion in executive committee, and the evidences from clinical studies, we have revised KMAP-BP for rapid cycling.

A Case of Ultra-rapid Cycling Bipolar Disorder Recovered by Lamotrigine Combination / 대한정신약물학회지

The anticonvulsant lamotrigine has been reported to be efficacious and well tolerated in treatment of bipolar patients. Recently, its efficacy in rapid cycling states has attracted interest, however there was no reports about lamotrigine in treatment of ultra-rapid cycling bipolar disorder. Here we present the case of a male patient with bipolar disorder who developed an ultra-rapid cycling state. The addition of lamotrigine to prior valproate treatment succeeded to improve the ultra-rapid cycling.

Korean Medication Algorithm for Bipolar Disorder(IV): Rapid Cycling / 대한정신약물학회지

OBJECTIVE: Treating rapid cycling bipolar disorder has many clinical problems such as recurrence, treatment resistance, and unstable course. Recent developments of medications including atypical antipsychotics and new anticonvulsants make it difficult to choose appropriate pharmacological options. The Korean Society of Psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder including rapid cycling to aid clinical decisions. METHODS: The first survey was performed with the questionnaire based on `The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000'. Because of inconsistency among experts in some aspects, we carried out the second survey and discussed with related literature to make a proper algorithm. RESULTS: Generally no `treatment of choice' were demonstrated. The first-line treatment is the single mood stabilizer or combination of a mood stabilizer and an atypical antipsychotic. Another mood stabilizer or an antidepressant can be added for the next treatment. Lithium, divalproex, and carbamazepine are preferred as a mood stabilizer than the third generation anticonvulsants. CONCLUSION: With the results of two surveys and discussion in executive committee, we developed the algorithm for rapid cycling bipolar disorder.

Korean Medication Algorithm for Bipolar Disorder(IV): Rapid Cycling / 대한정신약물학회지

OBJECTIVE: Treating rapid cycling bipolar disorder has many clinical problems such as recurrence, treatment resistance, and unstable course. Recent developments of medications including atypical antipsychotics and new anticonvulsants make it difficult to choose appropriate pharmacological options. The Korean Society of Psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder including rapid cycling to aid clinical decisions. METHODS: The first survey was performed with the questionnaire based on `The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000'. Because of inconsistency among experts in some aspects, we carried out the second survey and discussed with related literature to make a proper algorithm. RESULTS: Generally no `treatment of choice' were demonstrated. The first-line treatment is the single mood stabilizer or combination of a mood stabilizer and an atypical antipsychotic. Another mood stabilizer or an antidepressant can be added for the next treatment. Lithium, divalproex, and carbamazepine are preferred as a mood stabilizer than the third generation anticonvulsants. CONCLUSION: With the results of two surveys and discussion in executive committee, we developed the algorithm for rapid cycling bipolar disorder.

Korean Medication Algorithm for Bipolar Disorder(I) / 대한정신약물학회지

OBJECTIVE: Treating patients with bipolar disorder has many problems such as recurrent various episodes, breakthroughs, treatment resistance, switching and worsening of its course. In addition to these obstacles, recent developments of psychiatric medications make it difficult to choose the appropriate pharmacological options. This study was performed to survey the expert opinion of medication treatment for bipolar disorder. METHODS: The survey questionnaire used in 'The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000' was translated in Korean and amended by executive committee according to Korean situations. Forty eight of 50 (96%) members of review committee completed the survey. RESULTS: In acute manic episode lithium or divalproex is a first-line drug as a monotherapy, and combination treatment is considered in partial or non-responder. Carbamazepine is also a first-line drug in dysphoric and mixed episodes. For moderate and more severe depression, an antidepressant is added with a mood stabilizer. For psychotic bipolar disorder, mania or depression, both atypical antipsychotics and high potency typical antipsychotics are preferred, but the latter is less likely to be recommended. A mood stabilizer should be used in rapid cycling bipolar illness. For manic episode in rapid cycler a mood stabilizer and an atypical antipsychotic drug are recommended in combination as an initial treatment. CONCLUSION: Most experts present strong consensus for many options concerning to initial strategies and first-line medications, although there are some non-consensus and gaps between research data and clinical usage in some steps. Nevertheless these data might be a cornerstone for producing the Korean medication algorithm for bipolar disorder.

A Case of Rapid Cycling Affective Disorder in Patient with Severe Premenstrual Syndrome / 신경정신의학

Authors report a case of rapid cycling affective disorder(RCAD) who has suffered severe premenstrual syndrome since her monarch. Even if what relationship and etiology these disorders may have are undetermined, premenstrual syndrome and RCAD indeed share many characteristics and estrogen may have central role in these disorders. Patient showed a significant decrease of cerebral blood flow of right temporal area on SPECT It is impressive that carbamazepine was more effective than lithium in treatment of this RCAD case.