Korean J Psychopharmacol.
2006 Jul;17(4):362-373.
Korean Medication Algorithm for Bipolar Disorder 2006(II): Manic Episode
- Affiliations
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- 1Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea.
- 2Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea. wmbahk@catholic.ac.kr
- 3Department of Psychiatry and Stress Research Institute, College of Medicine, Inje University, Seoul, Korea.
- 4Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.
- 5Department of Psychiatry, College of Medicine, Konkuk University, Chungju, Korea.
- 6Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.
- 7Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
- 8Department of Psychiatry, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
- 9Department of Psychiatry, College of Medicine, Hallym University, Anyang, Korea.
- 10Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea.
- 11Naju National Hospital, Naju, Korea.
- 12Korean College of Neuropsychopharmacology, Korean Society for Depressive and Bipolar Disorders, and Korean Academy of Schizophrenia, Seoul, Korea.
Abstract
OBJECTIVE
As clinician, it is very difficult to choose the pharmacotherapeutic strategies of bipolar disorder because of various clinical feature according to each episode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recently, rapid development in the research of bipolar disorder and psychopharmacology, including atypical antipsychotics and new anticonvulsants, make it more difficult to choose the appropriate pharmacological options. Therefore, we decided to revise the Korean Medication Algorithm Project for Bipolar Disorder 2002 (KMAP-BP 2002) in order to provide more proper guideline for clinicians.
METHODS
Like the previous version, KMAP-BP 2002, we performed the first survey using questionnaire comprising 37 special clinical situations and 645 selection items. Fifty-three members of the review committee completed the first survey. After the discussion of the results at the review committee meeting, we performed the second adjunctive survey. Finally, the executive committee analyzed the results and discussed the final production of algorithm considering scientific evidences.
RESULTS
The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and atypical antipsychotics, monotherapy of mood stabilizer, or monotherapy of atypical antipsychotics. As mood stabilizers, divalproex and lithium are accepted as the first-line agents. As atypical antipsychotics, quetiapine, olanzapine and risperidone are recommended as the first-line. Overall, atypical antipsychotics and combination therapy are accepted more widely than before. Among mood stabilizers, the preference of divalproex are increasing and that of carbamazepine are decreasing.
CONCLUSION
Based on the results of two surveys, the discussion in executive committee and review of evidences, we developed new algorithm presented here for manic episode. We expect this algorithm may provide clinicians good informations and advices about the treatment of bipolar disorder, manic episode.
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