J Korean Neuropsychiatr Assoc.
2022 May;61(2):133-142. 10.4306/jknpa.2022.61.2.133.
Korean Medication Algorithm Project for Bipolar Disorder 2022: Mixed Features
- Kim W
1 - Bahk WM2
- Woo YS2
- Jeong JH2
- Seo JS3
- Choo IH4
- Yang CM5
- Lee JG6
- Shim SH7
- Yoon BH8
- Park SY9
- Sohn I9
- Kim MD10
- Jung MH11
- Jon DI11
- Affiliations
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- 1Department of Psychiatry, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
- 2Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 3Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea
- 4Department of Psychiatry, College of Medicine, Chosun University, Gwangju, Korea
- 5Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Korea
- 6Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
- 7Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea
- 8Department of Psychiatry, Naju National Hospital, Naju, Korea
- 9Department of Psychiatry, Keyo Hospital, Uiwang, Korea
- 10Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
- 11Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- KMID: 2530034
- DOI: http://doi.org/10.4306/jknpa.2022.61.2.133
Abstract
Objectives
Treatment guidelines or an algorithm can help clinicians implement better practices and clinical decisions. Therefore, the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) was revised again through a consensus of expert opinion. The diagnosis and treatment of mixed features are not simple, and there are many things to discuss. We describe the preferences and recommendations from KMAP-BP 2022 for the treatment of mood episodes with mixed features.
Methods
We revised the KMAP-BP 2018 questionnaire and conducted the survey with 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.
Results
In first-step strategies for mixed features with more manic symptoms, a combination of a mood stabilizer and an atypical antipsychotic is the treatment of choice. Mood stabilizer monotherapy and atypical antipsychotic monotherapy are preferred strategies. For mixed features with more depressive symptoms, a combination of mood stabilizer and atypical antipsychotic, a combination of atypical antipsychotic and lamotrigine (LMT), atypical antipsychotic monotherapy, a combination of mood stabilizer and LMT, and mood stabilizer monotherapy are preferred. For mixed features with similar manic symptoms and depressive symptoms, a combination of mood stabilizer and atypical antipsychotic, atypical antipsychotic monotherapy, and mood stabilizer monotherapy are preferred.
Conclusion
For mixed features, a combination of mood stabilizer and atypical antipsychotic is generally preferred, and LMT is preferred for depressive symptoms. Compared with KMAP-BP 2018, more diverse strategies and drugs are being attempted for the treatment of mixed features.
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