한국형 양극성 장애 약물치료 알고리듬 2010 : 조증 삽화

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 2006 (KMAP-BP 2006) in order to provide more proper guideline for clinicians. Methods : Like the previous version, KMAP-BP 2006, we performed the first survey using questionnaire comprising 40 special clinical situations and 1151 selection item. Sixty-five members of the review committee completed the first survey. After the discussion of the results at the review committee meeting, we performed the second adjunctive survey. Finally, 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 atypical antipsychotics, and it is the treatment of choice. Valproic acid and lithium is chosen for the preferred mood stabilizer of the first-line treatment of acute manic episode. Atypical antipsychotics is more widely accepted than before, as the effective medication for all subtypes of manic episodes. Conclusion : Compared with the previous version. we find out that ‘treatment of choice’ increases and ‘no-consensus’ decreases in this revision. These suggests that the many clinicians agree with others in the treatment of acute manic episode, and the pharmacotherapy of manic episode become more obvious than before. Newer agents such as aripiprazoe and lamotrigine gains more awareness in the treatment of bipolar disorder. We expect this algorithm may provide clinicians good information and help about the treatment of bipolar disorder, manic episode.