Korean J Psychopharmacol.  2014 Apr;25(2):57-67.

Korean Medication Algorithm for Bipolar Disorder 2014: Manic Episode

Affiliations
  • 1Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. wmbahk@catholic.ac.kr
  • 2Department of Psychiatry, Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea.
  • 3Department of Psychiatry, Konkuk University Chungju Hospital, School of Medicine, Konkuk University, Chungju, Korea.
  • 4Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University and Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan, Korea.
  • 5Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
  • 6Department of Psychiatry, Jeju National University Hospital, Jeju, Korea.
  • 7Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, Korea.
  • 8Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea.
  • 9Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea.
  • 10Department of Psychiatry, Naju National Hospital, Naju, Korea.
  • 11Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Korea. yshin523@hanmail.net

Abstract


OBJECTIVE
The pharmacotherapy of bipolar disorder has many difficulties such as various clinical feature according to each episode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recent rapid development and 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 (KMAP-BP) 2010 in order to provide more proper guideline for clinicians.
METHODS
Like the previous version, KMAP-BP 2010, we performed the survey using questionnaire comprising 55 main questions in which 8 main questions and 478 sub-items for treatment of manic or hypomanic episode were included. Sixty-four members of the review committee completed the survey. The executive committee analyzed the results and discussed the final production of algorithm considering scientific evidence.
RESULTS
The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and an atypical antipsychotic, and it is the treatment of choice for euphoric, psychotic and dysphoric/mixed mania. The preference for monotherapy with atypical antipsychotic (for all three types of mania) or mood stabilizer (for euphoric mania) was increased in KMAP-BP 2014. Valproic acid and lithium are chosen as the preferred mood stabilizer of the first-line treatment of acute manic episode and valproic acid was the treatment of choice for all types of mania. Atypical antipsychotics is more widely accepted than before in manic and hypomanic episode. Moreover, the preference for combination treatment in manic patients who failed to respond in early stage treatment was increased.
CONCLUSION
Compared with the previous version, we found that 'no-consensus' decreases in this revision. These suggest that the many clinicians agree with others in the treatment of acute manic/hypomanic episode, and the pharmacotherapy of manic/hypomanic episode become more obvious than before. Atypical antipsychotics such as aripiprazole, olanzapine and quetiapine gain more awareness in the treatment of bipolar mania and hypomania. We expect this algorithm may provide clinicians good information and help about the treatment of bipolar disorder, manic/hypomanic episode.

Keyword

Bipolar disorder; Manic episode; Pharmacotherapy; Algorithm

MeSH Terms

Advisory Committees
Anticonvulsants
Antipsychotic Agents
Bipolar Disorder*
Drug Therapy
Humans
Lithium
Psychopharmacology
Surveys and Questionnaires
Recurrence
Valproic Acid
Aripiprazole
Quetiapine Fumarate
Anticonvulsants
Antipsychotic Agents
Lithium
Valproic Acid
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