OBJECTIVE: This study aimed to evaluate the validity and reliability of a Korean version of the Mood Disorder Questionnaire-Adolescent version (K-MDQ-A) as a screening instrument for bipolar disorders in adolescents. METHODS: One hundred two adolescents with bipolar disorders and their parents were recruited from November 2014 to November 2016 at 7 training hospitals. One hundred six controls were recruited from each middle school in two cities of South Korea. The parent version of the original MDQ-A was translated into Korean. The parents of all participants completed the K-MDQ-A. The diagnoses of bipolar disorders were determined based on the Korean version of K-SADS-PL. The test-retest reliability with a 10-month interval was investigated in 33 bipolar adolescents. RESULTS: K-MDQ-A yielded a sensitivity of 0.90 and a specificity of 0.92 when using a cut-off score of endorsement of 5 items, indicating that symptoms occurred in the same time period and caused moderate or serious problems. The internal consistency of the K-MDQ-A was good. The correlations between each item and the total score ranged from 0.40 to 0.76 and were all statistically significant. Factor analysis revealed 3 factors that explained 61.25% of the total variance. The mean total score was significantly higher in bipolar adolescents (7.29) than in controls (1.32). The Pearson correlation coefficient for the total test-retest score was 0.59 (p < 0.001). CONCLUSION: The K-MDQ-A completed by parents showed the excellent validity and reliability and may be a useful screening tool for adolescents with bipolar disorders attending in- and outpatient psychiatric clinics.
Adolescent* ; Bipolar Disorder* ; Diagnosis ; Humans ; Korea ; Mass Screening* ; Mood Disorders* ; Outpatients ; Parents ; Reproducibility of Results* ; Sensitivity and Specificity

OBJECTIVES: The in-training examination (Performance Examination, PE) for psychiatric residents in Korea was launched 5 years ago by the Korean Neuropsychiatric Association (KNPA). This article analyzes 5-year accumulated data on the PE, and tries to make some suggestions for further development of the PE. METHODS: The 5-year data, previously utilized for the generation of formal annual reports were reanalyzed, with an emphasis on longitudinal trends. RESULTS: The analyses indicated the following; 1) Higher-year residents earned definitely higher scores than their lower-year colleagues on the PE. This trend was especially prominent in the area of psychopharmacology-biological psychiatry, geriatric psychiatry, child and adolescent psychiatry, and the emergency-organic psychiatry. There was no year-related performance difference in the area of psychoses. 2) In the area of anxiety-somatization disorder, psychophysiological disorder, and geriatric psychiatry, the residents in the university-affiliated hospitals outperformed those in the specialized psychiatric hospitals. 3) Through analyzing multiple-times examinees, it was found that their first-and second-time performances were moderately correlated, and that their ranks tended to improve, demonstrating a continuously improving performance according to the training year. CONCLUSION: These result suggested that the KNPA PE is a feasible measure for the estimation of an individual resident's performance as well as the adequacy of the environment provided by the training institutes.
Academies and Institutes ; Adolescent ; Adolescent Psychiatry ; Child ; Child Psychiatry ; Geriatric Psychiatry ; Hospitals, Psychiatric ; Humans ; Korea ; Psychophysiologic Disorders ; Psychotic Disorders

The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002 and revised in 2006. The aim of this study was to compare the KMAP-BP 2006 with other recently published treatment guidelines for bipolar disorder. We conducted a systematic review of the six most recently published guidelines and treatment algorithms for bipolar disorder to compare the similarities and differences between these guidelines and the KMAPBP 2006. Most treatment guidelines had similarities in their treatment options. The guidelines generally advocated atypical antipsychotics as first-line treatment in the manic phase and lamotrigine in the depressive phase. While lithium and divalproex were commonly used as mood stabilizers in the manic phase, divalproex was recommended in mixed or dysphoric mania. Mood stabilizers or atypical antipsychotics were selected as first-line treatment in maintenance. Some guidelines were more concerned about special clinical situations such as pregnancy, obesity, metabolic syndrome, and elderly patients, which were not described in the KMAP-BP 2006. Our findings suggest that the medication strategies for bipolar disorder are based on data from recent studies and clinical experiences. Useful information and a rationale for making sequential treatment decisions can be provided by critically reviewing the treatment guidelines. The treatment algorithms and guidelines are not substitutes for clinical judgment, but can serve as critical references to complement individual clinical assessments.
Aged ; Antipsychotic Agents ; Bipolar Disorder ; Complement System Proteins ; Humans ; Judgment ; Lithium ; Obesity ; Pregnancy ; Triazines ; Valproic Acid

Adult ; Diagnosis, Differential ; Humans ; Maxilla ; Prognosis

OBJECTIVE: The development of treatment guidelines has emerged as an important element so as to standardize treatment and to provide clinicians with algorithms. From the previous publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP): rapid cycling in 2002, we revised that in 2006. METHODS: The questionnaire to survey the expert opinion of medication for rapid cycling was completed by the review committee consisting of 53 experienced Korean psychiatrists. It is composed of 7 questions, and each question includes various options. We classified the expert opinion to 3 categories based on the lowest category in which the confidence interval fell (6.5 < or = for first-line and 3.5< or = for second-line treatment). RESULTS: Generally, 'treatment of choice' for rapid cycling was not demonstrated. The first-line treatment is the combination of a mood stabilizer and an atypical antipsychotic. Combination of two mood stabilizers was preferred as next strategy. Divalproex and lithium were the first-line choice as mood stabilizer. Compared to the surveys in 2002, the preference for lamotrigine and atypical antipsychotics has increased while that of carbamazepine and antidepressant has decreased. CONCLUSION: With the result of the survey, the discussion in executive committee, and the evidences from clinical studies, we have revised KMAP-BP for rapid cycling.
Advisory Committees ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Expert Testimony ; Lithium ; Psychiatry ; Publications ; Surveys and Questionnaires ; Valproic Acid

OBJECTIVE: In 2002, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2002) was published to make clinical guidelines to understand and treat bipolar disorder, but due to recent reports of various studies and application of new drugs, the revision of treatment algorithm was inevitable. Therefore, we revised the KMAP-BP 2002 focused on the treatment strategies of bipolar depression. METHOD: The methods of this survey were similar to those of the KMAP-BP 2002. The review committee consisted of 70 experienced psychiatrists. Among the total 37 questions, 15 questions for bipolar depression were evaluated. We classified the expert opinions to 3 categories according to its confidence interval; first, second, and third line. Results: Compared to the previous algorithm, combination of mood stabilizers (MS) or atypical antipsychotics (AAP) and antidepressants is generally more recommended than antidepressant monotherapy for bipolar depression. Lithium and divalproex are the first-line treatment choices as well as MS. The preference for lamotrigine is increased, while that for carbamazepine is decreased. Olanzapine and quetiapine are preferred as the first-line AAP. Most antidepressants are not recommended as the first-line drug. The strategy for breakthrough of depression is changed into adding an antidepressant and/or AAP after combination of 2 MS. CONCLUSION: These results suggest that treatment of bipolar depression should be different from that of unipolar depression. The advanced new algorithm is considered to be useful and practical in the treatment of bipolar depression.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Depression ; Depressive Disorder ; Expert Testimony ; Lithium ; Psychiatry ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVE: In the last decade, a number of pharmacological agents have shown efficacy in the treatment of bipolar disorder. Traditionally, lithium has been considered as the treatment of choice of bipolar disorder. However, more recently, atypical antipsychotics and newly developed anticonvulsants have become increasingly popular alternatives to lithium. This study examined the prescribing patterns for medications to treat bipolar disorder in office-based psychiatric practice. METHODS: The data for the present study were collected by using structured record form from November 2005 to December 2005. Psychotropic medications were grouped into six categories ; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Prescription data of 700 cases with a diagnosis of bipolar disorder according to DSM-IV from 70 Korean psychiatrists were accessed. Severity, mood episode, psychiatric comorbidity and point of diagnosis related utilization rates were computed focusing on atypical antipsychotics. RESULTS: In 695 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 62.4% of subjects, anticonvulsants in 58.7%, lithium in 47.8%, antidepressants in 17.6%, and typical antipsychotics in 15.5% of subjects. About seventeen percent of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Lithium and typical antipsychotics prescription were less frequent in depressive subjects than subjects with other mood episodes. Prescription of atypical antipsychotics and antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications. CONCLUSION: The rapid progress of psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.

OBJECTIVE: Since the previous publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2002, there has been a substantial need for the revision of treatment algorithm due to rapid progress in the management for bipolar disorder. We focused on the maintenance treatment of bipolar I and bipolar II disorders of KMAP-BP revised in 2006. METHOD: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 70 experienced psychiatrists. It was composed of 37 questions, and each question includes various sub-items. We classified the expert opinion to 3 categories (the first-line treatment, the second-line, the third-line) by x2 test. A part of this revision regarding maintenance treatment had 6 items ; 2 on bipolar I and 4 on bipolar II disorder. RESULTS: There was no 'treatment of choice' in maintenance treatment. In case of bipolar I mania without history of depression, mood stabilizer (MS) monotherapy was 1st-line treatment. In maintenance management for bipolar II disorder, two treatment options were recommended. Treatment with MS alone or combinations of MS and atypical antipsychotics were preferred in recently recovered patients from hypomania. Atypical antipsychotics were more favored in the maintenance treatment for bipolar I and II disorders than previous KMAP-BP. CONCLUSIONS: There is no 'treatment of choice' in maintenance strategies for bipolar disorder. Atypical antipsychotics are more preferred than the previous KMAP-BP. Also there is an increasing interest on the maintenance use of lamotrigine in bipolar depression.

OBJECTIVE: As clinician, it is very difficult to choose the pharmacotherapeutic strategies of bipolar disorder because of various clinical feature according to each episode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recently, rapid development in the 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 2002 (KMAP-BP 2002) in order to provide more proper guideline for clinicians. METHODS: Like the previous version, KMAP-BP 2002, we performed the first survey using questionnaire comprising 37 special clinical situations and 645 selection items. Fifty-three 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 evidences. RESULTS: The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and atypical antipsychotics, monotherapy of mood stabilizer, or monotherapy of atypical antipsychotics. As mood stabilizers, divalproex and lithium are accepted as the first-line agents. As atypical antipsychotics, quetiapine, olanzapine and risperidone are recommended as the first-line. Overall, atypical antipsychotics and combination therapy are accepted more widely than before. Among mood stabilizers, the preference of divalproex are increasing and that of carbamazepine are decreasing. CONCLUSION: Based on the results of two surveys, the discussion in executive committee and review of evidences, we developed new algorithm presented here for manic episode. We expect this algorithm may provide clinicians good informations and advices about the treatment of bipolar disorder, manic episode.
Advisory Committees ; Anticonvulsants ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Lithium ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Risperidone ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVE: Since the publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2002, there has been a substantial need for the revision due to rapid progress in the management for bipolar disorder. We revised KMAP-BP in 2006. METHODS: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 53 experienced Korean psychiatrists. It is composed of 37 questions, and each question includes various sub-items. A part regarding treatment strategies for hypomanic episode and maintenance was newly investigated in this revision. We classified the expert opinion to 3 categories (the first-line, the second-line, or the third-line) by chi-square-test. RESULTS: For acute manic episode, the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) is the optimal first-line treatment. Most reviewers recommended divalproex or lithium as a MS. Among AAPs, olanzapine, quetiapine and risperidone were most preferred. On breakthrough manic episode, the optimization of MS or adding AAP was recommended. For moderate bipolar depressed patients, a MS monotherapy or MS with an antidepressant was preferred. Combination of a MS and an antidepressant was recommended as a first-line treatment in severe non-psychotic depression. MS with an AAP and the triple combination of MS, AAP and an antidepressant were recommended for severe bipolar depression with psychotic features. Lithium and divalproex were the first-line choice as MS. Most antidepressants were recommended as a second-line drug. The strategy for breakthrough depression was changed to adding antidepressant after combination of two MS. The combination therapy (MS+AAP or MS+MS) was the most preferred treatment for rapid cycling bipolar patients. There was no 'treatment of choice' in maintenance treatment. In case of bipolar I mania without history of depression, a MS monotherapy was a firstline treatment. In maintenance management for bipolar II disorder, a MS monotherapy or the combinations of a MS and an AAP was preferred. Overall, the preference for lamotrigine and AAP was increased compared to the KMAP-BP 2002. Olanzapine and quetiapine were preferred as the first-line AAP. The carbamazepine and typical antipsychotics were markedly less favored in KMAP-2006 than KMAP-BP 2002. CONCLUSION: These results suggest that the medication strategies of bipolar disorder are rapidly changing and it reflects the recent studies and clinical experiences.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder* ; Carbamazepine ; Depression ; Expert Testimony ; Humans ; Lithium ; Psychiatry ; Publications ; Surveys and Questionnaires ; Risperidone ; Valproic Acid ; Quetiapine Fumarate