Objective@#In 2001, the Korean College of Neuropsychopharmacology and the Korean Society for
Schizophrenia Research developed the Korean Medication
Algorithm Project for
Schizophrenia (KMAP-SPR 2001, revised 2006) through a
consensus of
expert opinion. The present study was carried out to support the second revision of the KMAP-SPR. @*
Methods@#Based on
clinical guidelines and studies on the
treatment of psychotic symptoms in
schizophrenia, the
Executive committee completed a draft of KMAP-SPR 2019. To obtain an expert
consensus, a
Review committee of 100 Korean
psychiatrists was formed and 69 responded to a 30-item
questionnaire. Based on their responses, the KMAP-SPR 2019 was finalized. @*Results@#The revised
schizophrenia algorithm now consists of 5 stages. At Stage 1, monotherapy with atypical
antipsychotics was recommended by expert reviewers as the first-line strategy. At Stage 2, most reviewers recommended the use of typical or atypical
antipsychotic drugs not used at Stage 1. At Stage 3, many reviewers agreed with the
administration of
clozapine. At Stage 4, a combination of
clozapine and other agents such as
antipsychotics,
mood stabilizers,
antidepressants, or
electroconvulsive therapy was recommended. At Stage 5, most reviewers recommended combined
treatment with an
antipsychotic other than
clozapine; and a
mood stabilizer,
antidepressant, or
electroconvulsive therapy. At any stage, prescribing long-acting
injectable antipsychotics at the discretion of the clinician was recommended. @*Conclusion@#Compared with previous versions, the KMAP-SPR 2019 now recommends using
clozapine earlier in
treatment-
refractory schizophrenia. In addition, the use of long-acting
injectable antipsychotics is now considered to be available at any stage.