Korean Medication Algorithm for Depressive Disorder: Comparisons with Other Treatment Guidelines

We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review.

Korean Medication Algorithm for Depressive Disorder 2012 (III): The Subtypes of Depression / 대한정신약물학회지

OBJECTIVE: Recently, the pharmacotherapy including antidepressants in treating depression is widely used. However, as a result of newer agents that are continuously introduced, pharmacological treatment strategy is also changing. To catch up this trend, Korean Medication Algorithm Project for Depressive Disorder was developed in 2002 and revised in 2006. Since the last revision, the third revision reflected the new research result and the latest trends in the areas of pharmacological treatment. METHODS: One hundred and twenty three psychiatrists who have vast clinical experiences in depressive disorder are primarily selected then survey was sent to them via mail, 67 surveys were retried. This survey is constructed with 44 questionnaires in which contained from overall treatment strategies to treatment strategies under the specific circumstances. Each treatment strategy or treatment option is evaluated with the overall score of nine and the following 95% confidence interval result treatment option were divided into three phases of recommendation; primary, secondary, tertiary. RESULTS: For dysthymic disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI) [(es)citalopram, fluoxetine, sertraline, paroxetine], serotonin-norepinephrine reuptake inhibitor (SNRI) (venlafaxine, duloxetine, milacipran), and mirtazapine, was recommended as the first line medications. For melancholic type, SSRI, SNRI, and mirtazapine were recommended as the first line medications. For atypical type and seasonal pattern, bupropion as well as SSRI, SNRI, and mirtazapine, were recommended as the first line medications. CONCLUSION: The preferences of antidepressants in experts were different according to the subtype of depression. These results suggest that clinicians have to consider the subtype of depression in the treatment of depressive disorders.

Korean Medication Algorithm for Depressive Disorder (IV): Child and Adolescent/The Elderly/Female / 대한정신약물학회지

OBJECTIVE: Since the introduction of selective serotonin reuptake inhibitor in 1980s, there have been many changes in the treatment strategies for depressive disorders. To be of help for clinicians to select appropriate treatment strategies, Korean Medication Algorithm Project for Major Depressive Disorder was developed in 2002 and revised in 2006. To reflect changes in treatment pattern for depressive disorders since 2006, we revised the previous algorithm and developed Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012). METHODS: 123 psychiatrists who have vast clinical experiences in treating depressive disorders are primarily selected, and the survey was sent to them via mails. Among them, 67 psychiatrists answered the survey. This survey was composed of 44 questionnaires of which the contents covered from overall treatment strategies to treatment strategies under the specific circumstances. Based on 95% confidence interval and overall scores, each treatment of option was classified into three categories of recommendation; first-line, second-line, and third-line treatment option. RESULTS: In child and adolescent, antidepressant monotherapy was selected as first-line treatment option for mild, moderate, and severe episode without psychotic features. The combination of antidepressant and atypical antipsychotics was advocated as first-line treatment option for severe episode with psychotic features. In geriatric depression, antidepressant monotherapy was advocated as treatment of choice for mild to moderate episode. For severe episode without psychotic features, antidepressant monotherapy was selected as first-line treatment option. For severe episode with psychotic features, combination of antidepressant and atypical antipsychotics was selected as treatment of choice. In premenstrual dysphoric disorder, antidepressant monotherapy was advocated as first-line treatment option. In postpartum depression, antidepressant monotherapy was selected as first-line treatment option for mild to moderate episode. For severe episode without psychotic features, both antidepressant monotherapy and combination of antidepressant and atypical antipsychotics were selected as first-line treatment option. For severe episode with psychotic features, both combination of antidepressant and atypical antipsychotics and combination of mood stabilizer and atypical antipsychotics were advocated as first-line treatment option. CONCLUSION: In KMAP-DD 2012, the recommendations for treatment options in Child and Adolescent Depressive Disorder and Geriatric Depression were newly introduced. In aspects of treatment options for Female Depression, KMAP-DD 2006 and KMAP-DD 2012 had some similarities. But there were some changes of the treatment strategies in KMAP-DD 2012 which seemed to reflect recent study results.

Screening of Bipolar Disorders in High School Students / 신경정신의학

OBJECTIVES: This study aimed to assess the prevalence of bipolar spectrum disorders among Korean high school students (individuals in late adolescence) using the Korean version of the Mood Disorder Questionnaire (K-MDQ). METHODS: Two thousand male and female participants were proportionately selected from among high school students nationwide. From November 2007 through February 2008, we conducted an epidemiological survey of, and administered the K-MDQ to, these participants, assessed their psychometric properties, and compared characteristics between K-MDQ-positive and K-MDQ-negative participants. RESULTS: The K-MDQ's internal consistency (Cronbach's alpha) was 0.74. The item-total score correlations ranged from 0.35 to 0.57, and all were statistically significant (p<.001). Factor analysis with varimax rotation revealed 3 factors that explained 42.6% of total variance. We found the cutoff endorsement of the K-MDQ score (7 or more in criteria 1) in 1207 students (60.4%) and found 104 (5.2%) subjects were K-MDQ-positive, meeting all 3 K-MDQ criteria. The mean K-MDQ total score was 7.2+/-2.9 and total scores of K-MDQ-positives and K-MDQ-negatives were 9.9+/-1.7 and 7.0+/-2.9, respectively. K-MDQ-positives and K-MDQ-negatives showed no differences in the sociodemographic variables we assessed. Endorsement of items in total subject ranged from 15.7% to 77.7%. All items except item 8 (more energy) differed significantly in endorsement between K-MDQ-positives and K-MDQ-negatives. Items accounting for over 30% of the endorsement differences between K-MDQ-positives and K-MDQ-negatives were"feel so good," "so irritable," and"excessive, foolish, risky behavior." CONCLUSION: The K-MDQ was a relatively valid screening tool for Korean high school students. Per the result of the K-MDQ survey, suspected lifetime prevalence of bipolar spectrum disorders for those in late adolescence (high school students) seems to be 5.2%, suggesting that systemic screening for bipolar spectrum disorder should be required for this age group.

Life and Medical Activities of Yun Ti Wang / 의사학

Yun Ti Wang studied medicine in England, different from other Korean medical doctors in early days. Yun, who entered medical school at Glasgow University in England in March 1919, graduated with a Bachelor of Medicine in October 1925, along with an England medical license. Yun began working as an instructor at Severance Medical College from November 1927, and received Doctor of Medicine from the College of Obstetricians and Gynecologists at Kyoto Imperial University in August 1936. After the Liberation, Yun began working as a faculty member at the medical school at Seoul University, and he also worked as a Chief of the Second Medical Clinic of the school from 1946. Yun made a great effort in order to build an integrated committee, eventually contributing to the launching of Joseon Medical Associates in 1947. He was also elected as a first president at Joseon Obstetrics and Gynecology Associates, which was organized at the same year as the Joseon Medical Associates. Yun entered military as an army surgeon in April 1949 and has worked there until he was appointed as a principal at the Army Medical School in September 1953. His contributions to the development of military medical services include the following: expansion of medical facilities in army, stable system of workforce in military medical service, launching of Medical Aid and establishment of Department of Medical Care, and introduction of new medical technologies in anesthesiology and neurosurgery, etc. The career of Yun can be largely divided into the field of gynecology and military medical services. In the gynecological field, Yun contributed to the settlement of obstetrics in Korea, by taking in charge of the obstetrics class at Severance following medical missionaries. As for the military medical services, he has contributed to the establishment of military medical system as well as to the opening of new academic areas. The impact of his activities on the establishment of military medical services is especially significant, since it was a field that no Korean citizens had access to during the colonization era.

Life and Activities of Chu Hyun Chik / 의사학

Chu Hyun Chik was one of those who graduated first from Jejungwon Medical School in 1908, and had carried on an independence movement as well as religious, educational, and social movement both as a doctor and a Christian. He opened the Inje Hospital in Sunchon, North Pyeongan Province in 1909, and was put in prison on charges of being involved in Incident of '105 People' as he joined in Sinminhoe in which christians(Christians) from Gwanseo showed their initiative. With 3.1 Movement as a momentum, he started to raise funds for an independence movement mainly in North Pyongan Province, as a councilor of the Ministry of Finance of Shanghai Provisional Government of Korea. After he moved into Andong, Manchuria, he continued to support the spread of an independence movement by connecting Shanghai Provisional Government of Korea with the country. In October, 1919, he came to Sanghai as an exile and lead diverse activities as a member of Shin Han young man party and one of the leading men of Korean Christendom, especially related to An Chang Ho and christians around him and joining in Hungsadan. In 1925 when he returned home, he opened the Dongje Hospital and devoted himself to the developments of religious, educational, and social movement as a president of YMCA, Sunchon and an executive of a branch of Suyang Donguhoe in Sunch'?n. By Incident of Suyang Donguhoe he was put in prison, resisting Japanese Imperialism and died in 1942.