BACKGROUND: Diagnostic rate of Yersinia pseudotuberculosis infection by stool culture is low and slide agglutination (SA) method in serum has diagnostic problem due to high false positive rate and cross reaction with other febrile diseases. Therefore we tried to develop first stage whole cell Enzyme-linked immunosorbent assay (ELISA) test against Y. pseudotuberculosis antigen using Korean strains of Y. pseudotuberculosis. METHODS: Korean strains of Y. pseudotuberculosis (serotype:4b and 15) were cultured and cell wall was destroyed by sonifier and used as antigen. Microplate wells were coated with antigen and sera of three group (patient group, control group and adult group) were added and incubated at 37degreesC. Peroxidase conjugated rabbit antihuman IgG and goat antihuman IgM were added and substrate (3,3',5,5'-tetramethylbenzidine) adding was followed. Optical density was measured by spectrophotometer at 450 nm. RESULTS: Patient group (n=22) who has more than 1:80 titer in SA method showed 27.3% positivity in IgG antibody and 63.6% positivity in IgM antibody in noncompetitive sandwich method of ELISA test. Adult group (n=50) showed 26.0% positivity in IgG antibody. Positivity rate of antibody in ELISA test was not correlated with agglutination titer in SA method but both antibodies were positive in 3 cases which have agglutination titer above 1:1280. CONCLUSIONS: Whole cell ELISA test was tried by Y. pseudotuberculosis antigens using serotypes which were isolated in Korea. Positivity rate of both IgG and IgM antibodies by ELISA test was not correlated with agglutination titer of SA method.
Adult ; Agglutination ; Antibodies ; Cell Wall ; Control Groups ; Cross Reactions ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Goats ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Korea ; Peroxidase ; Yersinia pseudotuberculosis* ; Yersinia*

OBJECTIVES: In this study, we evaluated the maintenance-treatment strategies of bipolar I and bipolar II disorders of KMAP-BP 2018.METHODS: The questionnaire used to survey experts for their opinions of medication used for the treatment of bipolar disorder was completed by the review committee consisting of 84 experienced psychiatrists. It is composed of 50 questions, and each question includes various sub-items. The questionnaire for maintenance treatments was composed of overall treatment strategies after acute mood episodes in bipolar I and II disorders, including the choice of antipsychotic and antidepressant drugs, duration of medication, and treatment strategies used to achieve a breakthrough in symptoms.RESULTS: In case of bipolar I disorder, mood stabilizer monotherapy, a combination of mood stabilizer and atypical antipsychotic drugs, and atypical antipsychotic drug monotherapy were the first-line treatments. In maintenance management for bipolar II disorder, combinations of mood stabilizer and mood stabilizer monotherapy or atypical antipsychotic monotherapy were preferred. Atypical antipsychotic drugs were favored as the maintenance treatment for bipolar I and II disorders in KMAP-BP 2018.CONCLUSION: There have been growing bodies of tendency that atypical antipsychotics are more preferred than previously in the KMAP-BP 2014.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder ; Mood Disorders ; Psychiatry

OBJECTIVES: The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP), which was first published in 2002 and updated in 2006, 2010 and 2014, is revised again through the expert's consensus of opinion.METHODS: Out of eighty-four member of the review committee, sixty-one members completed the survey. We analyzed the answers, and thus discussed the data and held a clinician hearing on the results. Therefore, we report the results of KMAP-BP 2018.RESULTS: The preferred first-step strategies for acute euphoric mania are the combination of mood stabilizer (MS) and atypical antipsychotics (AAP), MS monotherapy and AAP monotherapy. For psychotic mania, combination of MS and AAP, and AAP monotherapy are preferred. The first-step strategies for acute bipolar, mild to moderate, depression are MS monotherapy, lamotrigine (LTG) monotherapy, AAP monotherapy, MS+AAP combination, AAP+LTG combination and MS+LTG combination. For non-psychotic severe depression, the MS+AAP combination, AAP+LTG combination and MS+LTG combination are preferred. For psychotic severe depression, the MS+AAP, AAP+antidepressant (AD) and AAP+LTG are preferred.CONCLUSION: We surveyed the expert consensus for the treatment of bipolar disorders and developed KMAP-BP 2018. We hope that this KMAP-BP 2018 is going to be helpful for clinicians to treat the patients with bipolar disorder.
Advisory Committees ; Antipsychotic Agents ; Bipolar Disorder ; Consensus ; Depression ; Hearing ; Hope ; Humans

OBJECTIVES: The Korean Medication Algorithm for Bipolar Disorder 2018 (KMAP-BP 2018) has been revised again as a result of a consensus of opinions among experts. The mixed episode was changed to mixed features in DSM-5. In this study, we will describe the preference and recommendation of KMAP-BP 2018 for the treatment of mood episodes with mixed features.METHODS: Out of 84 members of the review committee, 61 completed the survey. We analyzed the answers, discussed the data, and held a clinician hearing.RESULTS: The preferred first-step strategies for mixed features with more manic symptoms were a combination of mood stabilizers (MS), atypical antipsychotics (AAP), and AAP monotherapy. For mixed features with more depressive symptoms, a combination of MS and lamotrigine (LTG), a combination of MS and AAP, and a combination of AAP and LTG were preferred. For mixed features with manic and depressive symptoms, a combination of MS and AAP, and AAP monotherapy were preferred.CONCLUSION: For mixed features, a combination of MS and AAP was generally preferred, and lamotrigine was preferred for depressive symptoms. We hope this KMAP-BP 2018 to be helpful for clinicians that treat patients with bipolar disorder in Korea.
Advisory Committees ; Antipsychotic Agents ; Bipolar Disorder ; Consensus ; Depression ; Hearing ; Hope ; Humans ; Korea

Objectives: Treatment guidelines or an algorithm can help clinicians implement better practices and clinical decisions. Therefore, the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) was revised again through a consensus of expert opinion. The diagnosis and treatment of mixed features are not simple, and there are many things to discuss. We describe the preferences and recommendations from KMAP-BP 2022 for the treatment of mood episodes with mixed features. Methods: We revised the KMAP-BP 2018 questionnaire and conducted the survey with expert clinicians. Out of ninety-three members of the review committee, eighty-seven completed the survey. We analyzed the answers, discussed the data, and held a clinician hearing. Results: In first-step strategies for mixed features with more manic symptoms, a combination of a mood stabilizer and an atypical antipsychotic is the treatment of choice. Mood stabilizer monotherapy and atypical antipsychotic monotherapy are preferred strategies. For mixed features with more depressive symptoms, a combination of mood stabilizer and atypical antipsychotic, a combination of atypical antipsychotic and lamotrigine (LMT), atypical antipsychotic monotherapy, a combination of mood stabilizer and LMT, and mood stabilizer monotherapy are preferred. For mixed features with similar manic symptoms and depressive symptoms, a combination of mood stabilizer and atypical antipsychotic, atypical antipsychotic monotherapy, and mood stabilizer monotherapy are preferred. Conclusion For mixed features, a combination of mood stabilizer and atypical antipsychotic is generally preferred, and LMT is preferred for depressive symptoms. Compared with KMAP-BP 2018, more diverse strategies and drugs are being attempted for the treatment of mixed features.

Objectives: The pharmacotherapy of bipolar disorder is complex. A treatment guideline or algorithm can help clinicians implement better practices and clinical decisions. Therefore, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was revised through expert consensus on pharmacotherapy for bipolar disorder. Methods: We revised the KMAP-BP 2018 questionnaire and conducted a survey of expert clinicians. Out of ninety-three members of the review committee, eighty-seven completed the survey. We analyzed the answers, discussed the data, and held a clinician hearing. Here, we report the results from KMAP-BP 2022. Results: The preferred first-step strategies for acute euphoric mania are a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP), MS monotherapy, and AAP monotherapy. For psychotic mania, an MS and AAP combination, and AAP monotherapy are preferred. For hypomania, MS monotherapy and AAP monotherapy are preferred. The first-step strategies for mild to moderate bipolar depression are MS monotherapy, lamotrigine (LMT) monotherapy, AAP monotherapy, an MS+AAP combination, and an AAP+LMT combination. For non-psychotic severe depression, the MS+AAP combination, the AAP+LMT combination, and the MS+LMT combination are preferred. For psychotic severe depression, MS+AAP and AAP+LMT are preferred. Conclusion We obtained expert consensus and developed KMAP-BP 2022. Compared with KMAP-BP 2018, we can figure out clinicians’ preferences and decisions in real clinical situations more clearly. The preference for AAP increased, and that of MS and an antidepressant decreased. We hope KMAP-BP 2022 is helpful for clinicians who treat patients with bipolar disorder.

Objectives: In this study, we investigated and organized the maintenance-treatment strategies for Bipolar I and II disorders outlined in The Korean Medication Algorithm Project for Bipolar disorder 2022 (KMAP-BP 2022). Methods: The questionnaire sought to survey expert opinion on medication for bipolar disorders and was completed by a review committee consisting of 87 experienced Korean psychiatrists. It comprised 56 questions, and each question included various sub-items. The questionnaire for the maintenance treatments covered overall treatment strategies after acute mood episodes in bipolar I and II disorders, the choice of mood stabilizers and atypical antipsychotics and antidepressants, duration of medication, and treatment strategies for breakthrough symptoms. Results: In the case of bipolar I disorder, mood stabilizer monotherapy, atypical antipsychotics monotherapy, and a combination of mood stabilizers and atypical antipsychotics were selected as the first-line treatments. In maintenance management of bipolar II disorder, mood stabilizer monotherapy, atypical antipsychotics monotherapy, and combinations of mood stabilizers were selected as the preferred first-line treatments. Conclusion There has been a growing body of evidence that atypical antipsychotics have a greater preference than observed in the previous KMAP-BP of 2018. Also, monotherapy of mood stabilizers or atypical antipsychotics was more frequently selected in KMAP-BP 2022 than in the KMAP-BP 2018.