Revised Korean medication algorithm for bipolar disorder.

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Medicine

Background:

• The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) requires updates due to rapid advancements in treatment options.
• Previous KMAP-BP guidelines were published in 2002, necessitating a revision to reflect current clinical practice and research.

Purpose of the Study:

• To revise the KMAP-BP 2002 by surveying Korean expert opinions on current treatment strategies for bipolar disorder.
• To establish an updated, evidence-based medication algorithm reflecting recent clinical trials and expert consensus.

Main Methods:

• A questionnaire with 37 questions and 645 treatment options was distributed to 70 selected Korean experts.
• Expert opinions were collected and classified into first-, second-, and third-line treatments.
• The algorithm was developed using expert consensus, supplemented by recent clinical trial findings.

Main Results:

• For acute manic episodes, the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) was the preferred first-line treatment.
• Divalproex and lithium were recommended as MSs, while olanzapine, quetiapine, and risperidone were favored AAPs.
• For depression, MS monotherapy and MS-antidepressant combinations were preferred, with most antidepressants rated as second-line options.
• Lamotrigine and AAPs showed increased preference compared to the 2002 guidelines.

Conclusions:

• Medication strategies for bipolar disorder are rapidly evolving, as indicated by the updated KMAP-BP.
• The revised algorithm reflects current clinical experiences and recent research findings in bipolar disorder treatment.
• Expert consensus plays a crucial role in developing and updating clinical practice guidelines for complex psychiatric conditions.