Korean Medication Algorithm for Schizophrenia 2019, Third Revision: Treatment of Psychotic Symptoms
Jung Suk Lee 1, Je-Yeon Yun 2, 3, Shi Hyun Kang 4, Seung Jae Lee 5, Joon-Ho Choi 6, Beomwoo Nam 7, Seung-Hwan Lee 8, Young-Chul Chung 9, Chan-Hyung Kim 10*
1Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, 2Seoul National University Hospital, Seoul, 3Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, 4Department of Adult Psychiatry, National Center for Mental Health, Seoul, 5Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, 6Department of Psychiatry, College of Medicine, Hanyang University and Mental Health Institute, Seoul, 7Department of Psychiatry, Konkuk University School of Medicine, Chungju, 8Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, 9Department of Psychiatry, Chonbuk National University Medical School, Jeonju, 10Institute of Behavioral Science in Medicine and Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
Received: December 13, 2019; Revised: January 28, 2020; Accepted: March 4, 2020; Published online: March 4, 2020.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objective: In 2001, the Korean College of Neuropsychopharmacology and the Korean Society for Schizophrenia Research developed the Korean Medication Algorithm Project for Schizophrenia (KMAP-SPR) through an expert consensus of opinion, and updated in 2006. This study constitutes the third revision of the KMAP-SPR.
Methods: A 30-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for schizophrenia. The review committee included 69 Korean psychiatrists.
Results: The current schizophrenia algorithm consists of 5 stages. Atypical antipsychotics monotherapy was recommended at Stage 1. Stage 2 is the use of typical or atypical antipsychotic drugs which were not used at Stage 1. Clozapine is the Stage 3 treatment for schizophrenia. Stage 4 consists of the combination of clozapine and other drugs such as antipsychotics, mood stabilizer and antidepressant. Stage5 is the combined treatment of the antipsychotics other than clozapine, mood stabilizer, antidepressant and electroconvulsive therapy. According to clinician’s decision, long-acting injectable antipsychotics can be prescribed at any stage.
Conclusion: Compared to previous versions, it is recommended to use clozapine earlier in treatment-refractory schizophrenia in the KMAP-SPR 2019. Also, the use of long-acting injectable antipsychotics were available at any stage.
Keywords: Schizophrenia, Algorithms, Drug therapy, Expert consensus, Practice guideline


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