Korean J Psychopharmacol.  2003 Sep;14(3):223-230.

Korean Medication Algorithm for Bipolar Disorder(II): Manic Episode

• Shin YC
• Min KJ
• Jon DI
• Yoon BH
• Bahk WM

Abstract

OBJECTIVE
Treating patients with acute manic episode has many problems such as recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recent developments of medication, including atypical antipsychotics and new mood stabilizers, make it difficult to choose the appropriate pharmacological options. The Korean Society of Psychopharmacology and Korean Academy of Schizophrenia have started to develop a Korean algorithm project to treat major mental disorders including manic patients with the better pharmacological treatments. METHODS: The first survey was performed with a questionnaire used in `The Expert Consensus Guideline Series-Medication Treatment of Bipolar Disorder 2000' (translated in Korean). Forty-eight members of the review committee completed the survey. However, there were some instances of non-consensus and gaps between research data and clinical usage in some steps. Hence we carried out a second survey to clarify these aspects and other minor problems. RESULTS: The first-line pharmacological treatment for acute manic episode is the initiation of either lithium plus an atypical antipsychotic, or divalproex plus an atypical antipsychotic. In the case of euphoric mania, monotherapy with lithium or divalproex can be first-line treatment, as well as in combination with an atypical antipsychotic. In the case of psychotic mania, we decided to recommend typical and atypical antipsychotics with a mood stabilizer as first-line treatment. For mixed and dysphoric episodes, according to the result of the second survey, carbamazepine also can be used as a first-line mood stabilizer. Alternative mood stabilizers include new anticonvulsants such as lamotrigine and topiramate. Clozapine can be used for refractory cases and electroconvulsive therapy (ECT) can be used at any time, if needed, on the clinician's discretion. CONCLUSION: Based on the results of two surveys, discussion in executive committee and review of journals about pharmacological treatment of acute mania, we developed the algorithm presented here for manic episode. As this algorithm may retain problems and shortcomings, we will continue to revise these issues.

Keyword

Bipolar disorder; Manic episode; Pharmacotherapy; Algorithm

MeSH Terms

Advisory Committees
Anticonvulsants
Antipsychotic Agents
Bipolar Disorder
Carbamazepine
Clozapine
Consensus
Drug Therapy
Electroconvulsive Therapy
Humans
Lithium
Mental Disorders
Psychopharmacology
Surveys and Questionnaires
Recurrence
Schizophrenia
Valproic Acid
Anticonvulsants
Antipsychotic Agents
Carbamazepine
Clozapine
Lithium
Valproic Acid