J Korean Neuropsychiatr Assoc.  2022 May;61(2):98-109. 10.4306/jknpa.2022.61.2.98.

Korean Medication Algorithm Project for Bipolar Disorder 2022: Overview

• Kim W
• Bahk WM
• Woo YS
• Jeong JH
• Seo JS
• Choo IH
• Yang CM
• Lee JG
• Shim SH
• Jung MH
• Jon DI
• Park SY
• Sohn I
• Kim MD
• Yoon BH

• KMID: 2530027
• DOI: http://doi.org/10.4306/jknpa.2022.61.2.98

Abstract

Objectives
The pharmacotherapy of bipolar disorder is complex. A treatment guideline or algorithm can help clinicians implement better practices and clinical decisions. Therefore, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was revised through expert consensus on pharmacotherapy for bipolar disorder.
Methods
We revised the KMAP-BP 2018 questionnaire and conducted a survey of expert clinicians. Out of ninety-three members of the review committee, eighty-seven completed the survey. We analyzed the answers, discussed the data, and held a clinician hearing. Here, we report the results from KMAP-BP 2022.
Results
The preferred first-step strategies for acute euphoric mania are a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP), MS monotherapy, and AAP monotherapy. For psychotic mania, an MS and AAP combination, and AAP monotherapy are preferred. For hypomania, MS monotherapy and AAP monotherapy are preferred. The first-step strategies for mild to moderate bipolar depression are MS monotherapy, lamotrigine (LMT) monotherapy, AAP monotherapy, an MS+AAP combination, and an AAP+LMT combination. For non-psychotic severe depression, the MS+AAP combination, the AAP+LMT combination, and the MS+LMT combination are preferred. For psychotic severe depression, MS+AAP and AAP+LMT are preferred.
Conclusion
We obtained expert consensus and developed KMAP-BP 2022. Compared with KMAP-BP 2018, we can figure out clinicians’ preferences and decisions in real clinical situations more clearly. The preference for AAP increased, and that of MS and an antidepressant decreased. We hope KMAP-BP 2022 is helpful for clinicians who treat patients with bipolar disorder.

Keyword

Bipolar disorder; KMAP-BP 2022; Pharmacotherapy; Algorithm