J Korean Neuropsychiatr Assoc.  2022 May;61(2):110-122. 10.4306/jknpa.2022.61.2.110.

Korean Medication Algorithm Project for Bipolar Disorder 2022: Manic Episode

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

• KMID: 2530028
• DOI: http://doi.org/10.4306/jknpa.2022.61.2.110

Abstract

Objectives
The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) is a consensus-based medication guideline. To reflect advances in pharmacotherapy for bipolar disorders, we updated KMAP-BP to provide more timely information for clinicians.
Methods
We conducted a survey using a questionnaire on treatments formanic/hypomanic episodes. Eighty-seven members among ninety-three members of the review committee (93.5%) completed the survey. Each treatment strategy or treatment option for manic/hypomanic episodes was evaluated with an overall score of 9, and the resulting 95% confidence interval treatment options were categorized into three recommendation levels (primary, secondary, and tertiary). The executive committee analyzed the results and discussed the final production of an algorithm by considering the scientific evidence.
Results
The combination of a mood stabilizer and an atypical antipsychotic, monotherapy with a mood stabilizer, or monotherapy with an atypical antipsychotic were recommended as the firstline pharmacotherapeutic strategy for the initial treatment of mania without psychotic features. The mood stabilizer and atypical antipsychotic combination was the treatment of choice, and atypical antipsychotic monotherapy was the first-line treatment for mania with psychotic features. When initial treatment fails, a combination of mood stabilizer+atypical antipsychotic and switching to another first-line agent is recommended. For hypomania, monotherapy with either mood stabilizer or atypical antipsychotic is the recommended first-line treatment, but the mood stabilizer+atypical antipsychotic combination is recommended as well.
Conclusion
It is notable that there were changes in the preferences for the use of individual atypical antipsychotics, and the preference for the use of mood stabilizer increased for treatment-resistant mania.

Keyword

Bipolar disorder; Manic episode; Hypomanic episode; Pharmacotherapy; Algorithm