한국형 양극성 장애 약물치료 알고리듬 2006(Ⅰ)

Abstract

Objective：Since the publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2002, there has been a substantial need for the revision due to rapid progress in the management for bipolar disorder. We revised KMAP-BP in 2006. Methods：The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 53 experienced Korean psychiatrists. It is composed of 37 questions, and each question includes various sub-items. A part regarding treatment strategies for hypomanic episode and maintenance was newly investigated in this revision. We classified the expert opinion to 3 categories (the first-line, the second-line, or the third-line) by χ²-test. Results：For acute manic episode, the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) is the optimal first-line treatment. Most reviewers recommended divalproex or lithium as a MS. Among AAPs, olanzapine, quetiapine and risperidone were most preferred. On breakthrough manic episode, the optimization of MS or adding AAP was recommended. For moderate bipolar depressed patients, a MS monotherapy or MS with an antidepressant was preferred. Combination of a MS and an antidepressant was recommended as a first-line treatment in severe non-psychotic depression. MS with an AAP and the triple combination of MS, AAP and an antidepressant were recommended for severe bipolar depression with psychotic features. Lithium and divalproex were the first-line choice as MS. Most antidepressants were recommended as a second-line drug. The strategy for breakthrough depression was changed to adding antidepressant after combination of two MS. The combination therapy (MS+AAP or MS+MS) was the most preferred treatment for rapid cycling bipolar patients. There was no ‘treatment of choice’ in maintenance treatment. In case of bipolar Ⅰ mania without history of depression, a MS monotherapy was a firstline treatment. In maintenance management for bipolar Ⅱ disorder, a MS monotherapy or the combinations of a MS and an AAP was preferred. Overall, the preference for lamotrigine and AAP was increased compared to the KMAP-BP 2002. Olanzapine and quetiapine were preferred as the first-line AAP. The carbamazepine and typical antipsychotics were markedly less favored in KMAP-2006 than KMAP-BP 2002. Conclusion：These results suggest that the medication strategies of bipolar disorder are rapidly changing and it reflects the recent studies and clinical experiences.