한국형 양극성 장애 약물치료 알고리듬 2010 : 특수 상황에서의 치료

Abstract

Objectives : The complexity of the treatment for bipolar disorder is often caused by the presence of comorbidities, plethora of psychiatric features, and reproductive issues. Not only psychiatric comorbidities such as panic disorder, obsessive compulsive disorder, and eating disorder, but also medical comorbidities are common in those with bipolar disorder. In particular, weight gain and obesity are often associated with various psychiatric medications for treatment of bipolar disorder. Therefore, we undertook a survey of expert opinion to help clinical decisions in these special situations. Methods : A written survey which asked about treatment strategies in the special clinical situations was prepared ; 1) weight gain, 2) treatment non-adherence, 3) prominent psychiatric features, 4) psychiatric comorbidities, 5) medical comorbidities, 6) pregnancy and breast feeding, and 7) genetic counseling. Treatment options were scored using a 9-point scale for rating appropriateness of clinical decisions. Sixty-five experts of the review committee completed the survey. We classified the expert opinion to 3 categories (first-line/preferred treatment, second-line/alternative treatment, the third-line/usually inappropriate treatment) by χ2 test. Guideline tables indicating preferred treatment strategies were then developed for each clinical situation. Results : Recommendations based on the expert survey results for the treatment of bipolar patients in the special situations are outlined. Conclusion : Within the limitation of expert opinion, authors hope that the results of this study provide valuable information to make clinical decision about the treatment of bipolar disorder in the complicated situations.