The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018) with other recently published guidelines for treating bipolar disorder. We reviewed a total of five recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2018 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy for mania. However, the KMAP-BP 2018 did not prefer monotherapy with MS or AAP for psychotic mania. Quetiapine, olanzapine and aripiprazole were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Most guidelines advocated newer AAPs as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs (such as asenapine, cariprazine, paliperidone, lurasidine, long-acting injectable risperidone and aripiprazole once monthly) became prominent. KMAP-BP 2018 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2018, predominantly in the treatment of psychotic mania and severe depression. Further studies were needed to address several issues identified in our review.
Aripiprazole ; Bipolar Disorder ; Depression ; Drug Therapy ; Lithium ; Paliperidone Palmitate ; Prescriptions ; Quetiapine Fumarate ; Risperidone ; Valproic Acid

BACKGROUND AND OBJECTIVES: We aimed to compare outcomes of complete revascularization (CR) versus culprit-only revascularization for ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) in the 2nd generation drug-eluting stent (DES) era. METHODS: From 2009 to 2014, patients with STEMI and MVD, who underwent primary percutaneous coronary intervention (PCI) using a 2nd generation DES for culprit lesions were enrolled. CR was defined as PCI for a non-infarct-related artery during the index admission. Major adverse cardiovascular event (MACE) was defined as cardiovascular (CV) death, non-fatal myocardial infarction, target lesion revascularization, or heart failure during the follow-up year. RESULTS: In total, 705 MVD patients were suitable for the analysis, of whom 286 (41%) underwent culprit-only PCI and 419 (59%) underwent CR during the index admission. The incidence of MACE was 11.5% in the CR group versus 18.5% in the culprit-only group (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.37–0.86; p<0.01; adjusted HR, 0.64; 95% CI, 0.40–0.99; p=0.04). The CR group revealed a significantly lower incidence of CV death (7.2% vs. 12.9%; HR, 0.51; 95% CI, 0.31–0.86; p=0.01 and adjusted HR, 0.57; 95% CI; 0.32–0.97; p=0.03, respectively). CONCLUSIONS: CR was associated with better outcomes including reductions in MACE and CV death at 1 year of follow-up compared with culprit-only PCI in the 2nd generation DES era.
Arteries ; Drug-Eluting Stents ; Follow-Up Studies ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Percutaneous Coronary Intervention

OBJECTIVE: In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. METHODS: Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. RESULTS: AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. CONCLUSION: The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.
Adult ; Aged ; Antipsychotic Agents ; Biological Therapy ; Consensus ; Depression ; Depression, Postpartum ; Depressive Disorder ; Depressive Disorder, Major ; Drug Therapy ; Electroconvulsive Therapy ; Female ; Humans ; Mood Disorders ; Pregnant Women ; Premenstrual Dysphoric Disorder ; Transcranial Magnetic Stimulation

OBJECTIVE: The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was first published in 2002 through an expert consensus of opinion, and updated in 2006, 2010, and 2014. This study constitutes the fourth revision of the KMAP-BP. METHODS: A 50-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of adult bipolar disorder and six items for pediatric bipolar disorder. The review committee included 84 Korean psychiatrists and 43 child and adolescent psychiatry experts. RESULTS: The preferred first-step strategies for acute mania were the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP), MS monotherapy, and AAP monotherapy. A combination of a MS and an AAP, and AAP monotherapy were preferred for psychotic mania. The first-step strategies for mild to moderate bipolar depression were monotherapy with MS, AAP, or lamotrigine (LMT), and the combination of a MS and an AAP or LMT, or a combination of an AAP and LMT. The combination of two among a MS, AAP, and LMT were preferred for non-psychotic severe depression. A combination of a MS and an AAP or the combination of an AAP with an antidepressant or LMT were the first-line options for psychotic severe depression. CONCLUSION: The recommendations of the KMAP-BP 2018 have changed from the previous version by reflecting recent developments in pharmacotherapy for bipolar disorder. KMAP-BP 2018 provides clinicians with a wealth of information regarding appropriate strategies for treating patients with bipolar disorder.
Adolescent ; Adolescent Psychiatry ; Adult ; Advisory Committees ; Bipolar Disorder* ; Child ; Consensus ; Depression ; Drug Therapy ; Humans ; Psychiatry

OBJECTIVES: We revised the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2014 to provide more timely information for the use of the information by clinicians.METHODS: We performed the survey using a questionnaire for the treatment of manic or hypomanic episode in the participants. There were sixty-one members of the review committee who completed the survey. The executive committee analyzed the results and discussed the final production of the applicable algorithm as considering the scientific evidence.RESULTS: The combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) was recommended as the treatment of choice (TOC), and a monotherapy with an AAP was the first-line pharmacotherapeutic strategy for the initial treatment of mania, with or without psychotic features. The MS monotherapy was the first-line choice therapy, but only for the non-psychotic mania patients. When the initial treatment failed, the TOC was a combination of a MS and an AAP in mania with or without psychotic features, and a combination of two AAPs was TOC for the psychotic mania, as well. For hypomania, the monotherapy with MS or AAP was the first-line as initial treatment, and the recommended switch to or add an AAP was recommended when the initial strategies failed.CONCLUSION: Compared with the previous version, the experts recommend more intensive interventions earlier when initial treatment failed to respond to a recommended monotherapy.
Advisory Committees ; Bipolar Disorder ; Drug Therapy ; Humans

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: 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 objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder 2014 for rapid cycling.METHODS: The questionnaires, which were intended to survey experts for their opinions of medication used for rapid cycling, were completed by the review committee, which consisted of 84 Korean expert psychiatrists. We classified the responses into three categories. based on the lowest category in which the confidence interval fall (6.5≤ for first-line and 3.5≤ for high second-line treatment).RESULTS: The first-line treatment was the combination of a mood stabilizer and an atypical antipsychotic. This combination strategy was the treatment of choice for manic episodes. Additionally, a mood stabilizer with lamotrigine therapy and an atypical antipsychotic with lamotrigine combinations were the first-line treatments for the depressive phase. Atypical antipsychotic monotherapy, mood stabilizer monotherapy, the combination of two mood stabilizers, and the triple combination of mood stabilizers, atypical antipsychotics, and antidepressants were preferred as the next strategies. The first-line medications in all cases were valproate, quetiapine, olanzapine and aripiprazole. Lithium was the first-line medication in depressive and hypomanic episodes, and lamotrigine was the first-line medication for the treatment of the depressive phase.CONCLUSION: Compared to the surveys in 2014, the preference for atypical antipsychotics and lamotrigine have increased, and modalities used as a second-line treatment were more diverse.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Aripiprazole ; Bipolar Disorder ; Lithium ; Psychiatry ; Quetiapine Fumarate ; Valproic Acid

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: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the fourth revision of KMAP-BP was completed in 2018 in order to reflect the recent rapid research and development into bipolar disorder and psychopharmacology.METHODS: According to the methodology of previous versions, KMAP-BP 2018 was revised using a questionnaire consisting of 10 questions. Among eighty-four experts of the review committee, sixty-one completed the survey.RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer (MS) combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Switching or adding AAP, lamotrigine, or MS as 2nd strategies and clozapine or augmentation of buspirone, stimulant, or thyroid hormone as 3rd strategies were recommended. Compared to the previous KMAP-BP series, preference of AAP and lamotrigine has increased in the treatment of bipolar depressive episode in KMAP-BP 2018. Among the AAPs, olanzapine, quetiapine, and aripiprazole were preferred.CONCLUSION: Compared with the previous versions, we found that more active pharmacological strategies using AAP and lamotrigine as initial and next treatment strategies, respectively, were preferred, although few drugs were approved for bipolar depression.
Advisory Committees ; Aripiprazole ; Bipolar Disorder ; Buspirone ; Clozapine ; Drug Therapy ; Psychopharmacology ; Quetiapine Fumarate ; Thyroid Gland