Purpose: We present ultrasound-guided percutaneous low-dose thrombin (200–250 IU) injection for the treatment of iatrogenic femoral pseudoaneurysms. Second, we compared patient and procedure factors between subcutaneous hematoma and pseudoaneurysm groups. Materials and Methods: From April 2012 to May 2018, 8425 patients underwent neurointervention. Among these patients, 18 had small subcutaneous hematomas and 6 had pseudoaneurysms. Pseudoaneurysms in the neck and entire sac were visualized, and low-dose thrombins were injected while visualizing a “whirlpool” hyperechoic core in the pseudoaneurysm sac. Subcutaneous hematomas were treated with simple compression. We compared the following parameters between the subcutaneous hematoma group and pseudoaneurysm group: sex, age, body mass index (BMI), type of procedure, heparin usage, sheath size, procedure time, and number of previous neurointervention procedures with the Mann-Whitney U test. Results: Most of the pseudoaneurysms were successfully occluded with 200 IU of thrombin (n=5). Only 1 pseudoaneurysm required a slightly higher thrombin concentration (250 IU, n=1). During the short-term follow-up, no residual sac was observed and no surgical repair was necessary. Pain in the groin region was alleviated. During the 1-month follow-up, no evidence of pseudoaneurysm recurrence nor subcutaneous hematoma was noted. Patient factors (sex, age, and BMI) and procedure factors (heparin usage, sheath size, procedure time, number of previous procedures) were not statistically different between the subcutaneous hematoma and pseudoaneurysm groups. Conclusion Ultrasound-guided percutaneous low-dose thrombin injection (200–250 IU) is safe, effective, and less invasive for treating iatrogenic femoral pseudoaneurysm in neurointervention.

OBJECTIVE: It is not easy to diagnose bipolar disorders accurately in the clinical setting. Although Korean version of the Mood Disorder Questionnaire (K-MDQ) is easily administered, it still has weakness regarding case finding. In this study, we suggest a new weighted version of the K-MDQ to increase its screening power. METHODS: Ninety-five patients with bipolar disorders and 346 controls (patients with schizophrenia, patients with depressive disorders, patients with anxiety disorders, and subjects without any psychiatric disease) were enrolled in this study. The subjects received brief information on the K-MDQ, and then independently completed the questionnaire. RESULTS: Using odds ratios, we constructed a new weighted K-MDQ (W-K-MDQ). Item 1 (feel so good or hyper) was weighted 7 times and item 4 (less sleep) 3.5 times. Item 7 (easily distracted) and item 11 (more interested in sex) were excluded. Part 2 (simultaneity) and 3 (functional impairment) were also excluded as in the original K-MDQ. The sensitivity of the W-K-MDQ with a cutoff value of 10 was enhanced to 0.789. The area under the receiver operating characteristic curve was increased to 0.837. CONCLUSION: We suggested a new formula for K-MDQ using 11 of its items. The W-K-MDQ can be easily applied with good sensitivity to screen for bipolar disorders in clinical settings in Korea. Further evaluations with larger samples are needed to establish the usefulness of the W-K-MDQ.
Anxiety Disorders ; Bipolar Disorder ; Depressive Disorder ; Diagnosis, Differential ; Humans ; Korea ; Mass Screening* ; Mood Disorders* ; Odds Ratio ; ROC Curve ; Schizophrenia

OBJECTIVE: The complexity of the treatment for bipolar disorder is often caused by the presence of side effects of various psychiatric medications. In particular, weight gain and metabolic syndrome are currently major concerns in the medication for bipolar disorders. Therefore, we undertook a survey of expert opinion to help make clinical decisions in these special situations. METHODS: A written survey which asked about treatment strategies in the safety and tolerability was prepared; 1) weight gain, 2) antipsychotic related hyperprolactinemia, 3) lamotrigine related skin rash, 4) treatment non-adherence, and 5) genetic counselling. Treatment options were scored using a 9-point scale for rating appropriateness of clinical decisions in some issues. In other issues, experts were asked to choose to determine the ranking of preferences on the list. Sixty-four experts of the review committee completed the survey. We classified the expert opinions about preferences by chi2 test. RESULTS: Experts preferred behavioral and diet modification for weight gain, switching to prolactin-sparing-antipsychotics for antipsychotic-induced hyperprolactinemia, reducing dose of lamotrigene for its related benign skin rash, and prescribing once a day for treatment adherence. CONCLUSION: With the limitation of expert opinion, authors hope that the results of this study provide valuable information to make clinical decision about the treatment of bipolar disorder in the complicated situations.
Advisory Committees ; Bipolar Disorder* ; Exanthema ; Expert Testimony ; Food Habits ; Hope ; Hyperprolactinemia ; Weight Gain

OBJECTIVE: The third revision of Korean Medication Algorithm Project for Bipolar Disorder was performed in 2014 in order to provide more proper guideline for clinicians. In this study, we undertook a survey of expert opinion to help clinical decisions in medical comorbidities. METHODS: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 64 experienced psychiatrists. This survey was composed of 56 main questionnaires of which the contents covered from overall treatment strategies to treatment strategies under the specific situations. The executive committee analyzed the results and discussed the final production of algorithm. RESULTS: In bipolar patients with cardiovascular, diabetic, or hepatic comorbidities, aripiprazole was first-line treatment strategy. In case of renal comorbidity accompanying bipolar disorder, aripiprazole, valproate, and quetiapine were preferred. Valproate was recommended as the first-line strategy in case of bipolar disorder with cerebrovascular diseases. CONCLUSION: This study provided information about the consensus among experts in regard to treatment strategies for bipolar disorder in the medically ill.
Advisory Committees ; Bipolar Disorder* ; Comorbidity* ; Consensus ; Drug Therapy ; Expert Testimony ; Humans ; Psychiatry ; Surveys and Questionnaires ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the third revision of KMAP-BP was performed in 2014 in order to reflect the recent rapid development and research of bipolar disorder and psychopharmacology. METHODS: According to methodology of previous versions, KMAP-BP 2014 was revised using the same questionnaire consisting of 14 questions. Sixty-four experts of the review committee completed the survey. The executive committee analyzed the results and discussed the final production of algorithm considering scientific evidence. RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Compared to KMAP-BP 2010, preference of AAP has been increased in the treatment of bipolar depressive episode in KMAP-BP 2014. Among AAPs, olanzapine, quetiapine and aripiprazole were preferred. When considering the efficacy and safety simultaneously, (es)citalopram, bupropion, and sertraline were recommended among antidepressants for bipolar depression. CONCLUSION: Compared with the previous version, we found that more aggressive pharmacological strategies as an initial treatment were preferred, although various strategies were recommended as same as previous studies. Increased preference of AAP was prominent in KMAP-BP 2014. We expect this algorithm may be helpful in the treatment of bipolar disorder, depressive episode.
Advisory Committees ; Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Drug Therapy ; Psychopharmacology ; Surveys and Questionnaires ; Sertraline ; Aripiprazole ; Quetiapine Fumarate

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 (KMAP-BP) 2010 in order to provide more proper guideline for clinicians. METHODS: Like the previous version, KMAP-BP 2010, we performed the survey using questionnaire comprising 55 main questions in which 8 main questions and 478 sub-items for treatment of manic or hypomanic episode were included. Sixty-four members of the review committee completed the survey. 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 an atypical antipsychotic, and it is the treatment of choice for euphoric, psychotic and dysphoric/mixed mania. The preference for monotherapy with atypical antipsychotic (for all three types of mania) or mood stabilizer (for euphoric mania) was increased in KMAP-BP 2014. Valproic acid and lithium are chosen as the preferred mood stabilizer of the first-line treatment of acute manic episode and valproic acid was the treatment of choice for all types of mania. Atypical antipsychotics is more widely accepted than before in manic and hypomanic episode. Moreover, the preference for combination treatment in manic patients who failed to respond in early stage treatment was increased. CONCLUSION: Compared with the previous version, we found that 'no-consensus' decreases in this revision. These suggest that the many clinicians agree with others in the treatment of acute manic/hypomanic episode, and the pharmacotherapy of manic/hypomanic episode become more obvious than before. Atypical antipsychotics such as aripiprazole, olanzapine and quetiapine gain more awareness in the treatment of bipolar mania and hypomania. We expect this algorithm may provide clinicians good information and help about the treatment of bipolar disorder, manic/hypomanic episode.
Advisory Committees ; Anticonvulsants ; Antipsychotic Agents ; Bipolar Disorder* ; Drug Therapy ; Humans ; Lithium ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) was firstly published in 2002, with updates in 2006 and 2010. This third update reviewed the experts' consensus of opinion on the pharmacological treatments of bipolar disorder. METHODS: The newly revised questionnaire composed of 55 key questions about clinical situations including 223 sub-items was sent to the experts. Sixty-four of 110 experts replied. For the newly added section (treatment guideline for child and adolescent bipolar disorders) in KMAP-BP 2014, 23 of 38 experts replied to this special section. Data were analyzed according to the same methods to be used in conjunction with the previous publications. RESULTS: The recommendations for the management of acute mania remained largely unchanged. Combination of mood stabilizer (MS) and atypical antipsychotic (AAP) was the first-line treatment option in acute mania. Valproic acid (VP), lithium (Li), and several AAPs continued to be first-line treatments. MS or AAP monotherapy was the first-line treatment in hypomania. More frequent use of AAP as a first-line agent was noted in KMAP-BP 2014. For management of mild to moderate bipolar depression, MS monotherapy, combination of MS and AAP, combination of AAP and lamotrigine (LTG) was the first-line treatments. In severe non-psychotic depression, combination of MS and AAP, combination of AAP and LTG, and combination of MS and antidepressant (AD) was the first-line treatments. For the management of severe psychotic bipolar depression, combination of MS and AAP, combination of AAP and LTG, combination of MS, AAP and AD or LTG, combination of AAP and AD, and combination of AAP, AD and LTG was the first-line treatments. Li, VP, LTG, aripiprazole (ARP), olanzapine (OLZ) and quetiapine (QT) were the first-line treatment for bipolar depression. Although many treatment options were recommended, there were few consensus of opinion in bipolar depression. Treatment of mixed features was firstly added in KMAP-BP 2014. Combination of MS and AAP was the treatment of choice for management of mixed features. AAP monotherapy was also the first-line treatment. VP, Li, ARP, OLZ and QT were the first-line treatment for management of all phases of mixed features. Risperidone was added in mixed mania and LTG in mixed depressive features. There have been many treatment options for management of rapid cycling in bipolar disorder, when considered the combination of MS and AAP was only first-line treatment in KMAP-BP 2014. Combination of MS and AAP, MS or AAP monotherapy was the first-line options for management of maintenance phase after manic episode. For maintenance treatment after bipolar I depression, combination of MS and AAP, combination of MS and LTG, combination of AAP and LTG, MS or LTG monotherapy, and combination of MS, AAP and LTG were the first-line options. For management of maintenance phase of bipolar II depression, combination of AAP and LTG, combination of MS and LTG, combination of MS and AAP, AAP or LTG monotherapy were recommended as the first-line options. CONCLUSION: The experts' opinion of consensus was markedly changed in KMAP-BP 2014 than in previous publications. Preferred treatment with AAP and LTG was especially noted for management of bipolar disorder. We confirmed the treatment options recommended in KMAP-BP 2014 were much in concordance with current updated treatment guidelines for bipolar disorder. Despite the limitations of expert consensus guideline, KMAP-BP 2014 may reflect the current patterns of clinical practice and recent researches.
Adolescent ; Bipolar Disorder* ; Child ; Consensus ; Depression ; Humans ; Lithium ; Surveys and Questionnaires ; Risperidone ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: Psychopharmacological treatment of bipolar disorder is quite complex because of its clinical features of different episodes and various course. We published Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2002, that appeared to be helpful in clinical situation by feasibility study in 2005, and revised KMAP-BP in 2006. New papers in which some drugs are effective in treating bipolar disorder have been published, and the demand for revision of KMAP-BP are increased. METHODS: The questionnaire was sent to 94 experts, 65 of whom replied. It was composed of 40 questions about clinical situations, and each question includes various sub-items. Based on KMAP-BP 2006 and new data, some questions sub-items are amended. Safety issues and consideration on special populations were added in this revision. Each option was categorized on three parts (the first-line, the second-line, or the third-line) by its 95% confidence interval. RESULTS: In acute manic episode, even though it is euphoric, mixed, or psychotic, combination of a mood stabilizer (MS) with an atypical antipsychotic (AAP) is recommended as first-line strategy. Mood stabilizer monotherapy is first-line in hypomanic episode. Among the mood stabilizers, valproic acid and lithium are selected as first-line. Monotherapy with mood stabilizer is recommended in mild to moderate bipolar depression. However, triple combination of a mood stabilizer, an atypical antipsychotic and an antidepressant (AD), is the first-line strategy in non-psychotic severe depression. Also combination of MS and AAP (MS+AAP) and combination of MS and AD (MS+AD) are recommended as first-line. In psychotic bipolar depression, combination of MS, AAP, and AD (MS+AAP+AD), combination of MS and AAP (MS+AAP), and combination of AAP and AD (AAP+AD) are first-line strategies. In bipolar depression, lithium, lamotrigine, and valproic acid are selected as first-line mood stabilizer, and quetiapine, olanzapine and aripiprazole are preferred antipsychotics. Bupropion and (es)citalopram are first-line antidepressant in moderated depression, and (es)citalopram, bupropion, and paroxetine are recommended as firstline in severe depression. Preferred strategy for rapid cycling patients is combination of MS with AAP. In maintenance treatment, combination of MS with AAP and monotherapy of MS are recommended as first-line. CONCLUSION: In treating bipolar disorder, even the first step of treatment, consensus of experts are changed from our studies in 2002 and 2006. This medication algorithm, with some limitations, may reflect the clinical practice and recent researches.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Bupropion ; Consensus ; Depression ; Dibenzothiazepines ; Humans ; Lithium ; Oligopeptides ; Paroxetine ; Piperazines ; Surveys and Questionnaires ; Quinolones ; Resin Cements ; Triazines ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate

The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002 and thereafter revised in 2006. It was secondly revised in 2010 (KMAP-BP 2010). The aim of this study was to compare KMAP-BP 2010 with other recently published treatment algorithm and guidelines for bipolar disorder. The authors reviewed the 4 recently published guidelines and treatment algorithms for bipolar disorder [The British Association for Psychopharmacology Guideline for Treatment of Bipolar Disorder, Canadian Network for Mood and Anxiety Treatments Guidelines for the Management of Patients with Bipolar Disorder, The World Federation Society of Biological Psychiatry Guideline for Biological Treatment of Bipolar Disorder and National Institute for Health and Clinical Experience (NICE) Clinical Guideline] to compare the similarities and discrepancies between KMAP-BP 2010 and the others. In aspects of treatment options, most treatment guidelines had some similarities. But there were notable discrepancies between the recommendations of other guidelines and those of KMAP-BP in which combination or adjunctive treatments were favored. Most guidelines advocated new atypical antipsychotics as first-line treatment option in nearly all phases of bipolar disorder and lamotrigine in depressive phase and maintenance phase. Lithium and valproic acid were still commonly used as mood stabilizers in manic phase and strongly recommended valproic acid in mixed or psychotic mania. Mood stabilizers or atypical antipsychotics were selected as first-line treatment option in maintenance treatment. As the more evidences were accumulated, more use of atypical antipsychotics such as quetiapine, aripiprazole and ziprasidone were prominent. This review suggests that the medication strategies of bipolar disorder have been reflected the recent studies and clinical experiences, and the consultation of treatment guidelines may provide clinicians with useful information and a rationale for making sequential treatment decisions. It also has been consistently stressed that treatment algorithm or guidelines are not a substitute for clinical judgment; they may serve as a critical reference to complement of individual clinical judgment.
Antipsychotic Agents ; Anxiety ; Biological Psychiatry ; Bipolar Disorder ; Complement System Proteins ; Dibenzothiazepines ; Humans ; Judgment ; Lithium ; Piperazines ; Psychopharmacology ; Quinolones ; Thiazoles ; Triazines ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVES: The purpose of this study was to evaluate gender differences with respect to the internalization or externalization of symptoms according to the amount of time spent engaged in extracurricular education. METHODS: The study included a community sample of 755 boys and girls (mean age, 6.6 years), collected from five elementary schools in Gunpo, South Korea. Primary caregivers completed a questionnaire which included information on demographics, the amounts of time children spent in extracurricular education and with other activities, and an adapted form of the Behavior Assessment System for Children (BASC-2). Gender differences regarding externalizing and internalizing behavior problems were examined according to extracurricular education. RESULTS: With respect to the boys, there was a difference in the frequency of those who had externalizing behavior problems according to their time spent in extracurricular education. In contrast, the girls exhibited no difference. With respect to those children who spent a lot of time engaged in extracurricular education, there was a gender-specific difference only with respect to externalizing behavior problems. CONCLUSION: A gender-specific difference exists only in terms of externalizing behavior problems according to time spent engaged in extracurricular education.
Caregivers ; Child ; Demography ; Humans ; Republic of Korea ; Surveys and Questionnaires