Department of Psychiatry, Hallym University, Anyang, Korea.
World J Biol Psychiatry. 2009;10(4 Pt 3):846-55. doi: 10.1080/15622970802144865.
The rapid progress in treatments for bipolar disorder makes it necessary to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) published in 2002. This study was performed to timely revise KMAP-BP 2002. A questionnaire comprising 37 questions and 645 treatment options was developed for surveying the opinions of Korean experts. We classified the opinions into three categories: first-, second-, and third-line treatments. Fifty-three (75.7%) of the 70 selected experts answered the questionnaire. For an acute manic episode, the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) was the preferred first-line treatment. Most experts recommended divalproex and lithium as MSs, and olanzapine, quetiapine, and risperidone as AAPs. For moderately to severely depressed bipolar patients, MS monotherapy and a combination of an MS and an antidepressant (AD) were considered to be preferred treatments respectively. A combination of an MS and an AD was the preferred strategy in severe nonpsychotic depression. Most ADs were rated as second-line drugs. Overall, the preference for lamotrigine and AAPs was higher than in KMAP-BP 2002. The algorithm was developed mainly using consensus among experts supplemented with findings of recent clinical trials to ensure that our algorithm was both up to date and balanced. These results suggest that the medication strategies of KMAP-BP are changing rapidly, reflecting recent studies and clinical experiences.
双相障碍治疗的快速进展使得有必要修订 2002 年发表的《韩国双相障碍药物治疗算法项目》（KMAP-BP）。本研究旨在及时修订 KMAP-BP 2002。为了调查韩国专家的意见，我们编制了一份包含 37 个问题和 645 个治疗方案的问卷。我们将意见分为三类：一线、二线和三线治疗。在 70 名选定的专家中，有 53 名（75.7%）回答了问卷。对于急性躁狂发作，心境稳定剂（MS）和非典型抗精神病药（AAP）的联合治疗是首选的一线治疗。大多数专家建议使用丙戊酸钠和锂作为 MS，奥氮平、喹硫平、利培酮作为 AAP。对于中度至重度抑郁的双相患者，MS 单药治疗和 MS 与抗抑郁药（AD）的联合治疗分别被认为是首选治疗方法。MS 与 AD 的联合治疗是严重非精神病性抑郁症的首选策略。大多数 AD 被评为二线药物。总的来说，拉莫三嗪和 AAP 的偏好度高于 KMAP-BP 2002。该算法主要是在专家共识的基础上，结合最近的临床试验结果制定的，以确保我们的算法既具有时效性又具有平衡性。这些结果表明，KMAP-BP 的药物治疗策略正在迅速变化，反映了最近的研究和临床经验。
