Korean Medication Algorithm Project for Bipolar Disorder: third revision.
OBJECTIVE
To constitute the third revision of the guidelines for the treatment of bipolar disorder issued by the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP 2014).


METHODS
A 56-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for the various phases of bipolar disorder and for special populations. The review committee included 110 Korean psychiatrists and 38 experts for child and adolescent psychiatry. Of the committee members, 64 general psychiatrists and 23 child and adolescent psychiatrists responded to the survey.


RESULTS
The treatment of choice (TOC) for euphoric, mixed, and psychotic mania was the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP); the TOC for acute mild depression was monotherapy with MS or AAP; and the TOC for moderate or severe depression was MS plus AAP/antidepressant. The first-line maintenance treatment following mania or depression was MS monotherapy or MS plus AAP; the first-line treatment after mania was AAP monotherapy; and the first-line treatment after depression was lamotrigine (LTG) monotherapy, LTG plus MS/AAP, or MS plus AAP plus LTG. The first-line treatment strategy for mania in children and adolescents was MS plus AAP or AAP monotherapy. For geriatric bipolar patients, the TOC for mania was AAP/MS monotherapy, and the TOC for depression was AAP plus MS or AAP monotherapy.


CONCLUSIONS
The expert consensus in the KMAP-BP 2014 differed from that in previous publications; most notably, the preference for AAP was increased in the treatment of acute mania, depression, and maintenance treatment. There was increased expert preference for the use of AAP and LTG. The major limitation of the present study is that it was based on the consensus of Korean experts rather than on experimental evidence.
Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Young Sup
YS
Woo
Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, South Korea ; Paik Institute for Clinical Research, Inje Univeristy, Busan, South Korea.
Jung Goo
JG
Lee
Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Jong-Hyun
JH
Jeong
Department of Psychiatry, Jeju National University Hospital, Jeju, South Korea.
Moon-Doo
MD
Kim
Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, South Korea.
Inki
I
Sohn
Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, Cheonan, South Korea.
Se-Hoon
SH
Shim
Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, South Korea.
Duk-In
DI
Jon
Department of Psychiatry, School of Medicine, Konkuk University, Chungju, South Korea.
Jeong Seok
JS
Seo
Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
Young-Chul
YC
Shin
Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, South Korea.
Kyung Joon
KJ
Min
Department of Psychiatry, Naju National Hospital, Naju, South Korea.
Bo-Hyun
BH
Yoon
Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Won-Myong
WM
Bahk
expert consensus; pharmacological treatment; treatment guideline