Jeong Jong-Hyun, Bahk Won-Myong, Woo Young Sup, Yoon Bo-Hyun, Lee Jung Goo, Kim Won, Sohn InKi, Park Sung-Yong, Shim Se-Hoon, Seo Jeong Seok, Choo Il Han, Yang Chan-Mo, Jung Myung Hun, Jon Duk-In, Kim Moon-Doo
Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Clin Psychopharmacol Neurosci. 2023 Feb 28;21(1):32-48. doi: 10.9758/cpn.2023.21.1.32.
The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) with other recently published guidelines for treating bipolar disorder. We reviewed a total of six recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2022 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 in a same degree for mania. However, the KMAP-BP 2022 recommended MS + AAP combination therapy for psychotic mania, mixed mania and psychotic depression as treatment of choice. Aripiprazole, quetiapine and olanzapine were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Some guideline suggested olanzapine is a second-line options during maintenance treatment, related to concern about long-term tolerability. Most guidelines advocated newer AAPs (asenapine, cariprazine, long-acting injectable risperidone, and aripiprazole once monthly) 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. KMAP-BP 2022 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 2022, predominantly in the treatment of psychotic mania, mixed mania and psychotic depression.
本研究的目的是比较《2022年韩国双相情感障碍药物治疗算法项目》（KMAP-BP 2022）与其他近期发表的双相情感障碍治疗指南的建议。我们总共回顾了六项近期发表的全球治疗指南，并将KMAP-BP 2022的治疗建议与其他指南的建议进行了比较。对于躁狂发作的初始治疗，各治疗指南之间没有显著差异。所有指南均同等程度地推荐使用心境稳定剂（MS）或非典型抗精神病药物（AAP）单药治疗，或MS与AAP联合作为躁狂发作的一线治疗策略。然而，KMAP-BP 2022推荐将MS + AAP联合治疗作为精神病性躁狂、混合性躁狂和精神病性抑郁的首选治疗方法。阿立哌唑、喹硫平和奥氮平是所有指南中几乎双相情感障碍各阶段的一线AAPs。一些指南建议奥氮平在维持治疗期间作为二线选择，这与对其长期耐受性的担忧有关。大多数指南主张将新型AAPs（阿塞那平、卡立普唑、长效注射用利培酮和每月一次的阿立哌唑）作为各阶段的一线治疗选择，而拉莫三嗪则被推荐用于抑郁发作期和维持期。锂盐和丙戊酸在双相情感障碍的所有阶段都常用作MSs。KMAP-BP 2022指南与其他指南相似，反映了基于累积研究数据的双相情感障碍处方模式的当前变化。强烈倾向于联合治疗是KMAP-BP 2022的特点，主要体现在对精神病性躁狂、混合性躁狂和精神病性抑郁的治疗上。
