Korean Medication Algorithm for Schizophrenia 2019, Second 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: March 11, 2020; Accepted: March 12, 2020; Published online: March 12, 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 2001, revised 2006) through a consensus of expert opinion. The present study was carried out to support the second revision of the KMAP-SPR.
Methods: Based on clinical guidelines and studies on the treatment of psychotic symptoms in schizophrenia, the Executive committee completed a draft of KMAP-SPR 2019. To obtain an expert consensus, a Review committee of 100 Korean psychiatrists was formed and 69 responded to a 30-item questionnaire. Based on their responses, the KMAP-SPR 2019 was finalized.
Results: The revised schizophrenia algorithm now consists of 5 stages. At Stage 1, monotherapy with atypical antipsychotics was recommended by expert reviewers as the first-line strategy. At Stage 2, most reviewers recommended the use of typical or atypical antipsychotic drugs not used at Stage 1. At Stage 3, many reviewers agreed with the administration of clozapine. At Stage 4, a combination of clozapine and other agents such as antipsychotics, mood stabilizers, antidepressants, or electroconvulsive therapy was recommended. At Stage 5, most reviewers recommended combined treatment with an antipsychotic other than clozapine; and a mood stabilizer, antidepressant, or electroconvulsive therapy. At any stage, prescribing long-acting injectable antipsychotics at the discretion of the clinician was recommended.
Conclusion: Compared with previous versions, the KMAP-SPR 2019 now recommends using clozapine earlier in treatment-refractory schizophrenia. In addition, the use of long-acting injectable antipsychotics is now considered to be available at any stage.
Keywords: Schizophrenia, Algorithm, Drug therapy, Expert consensus, Practice guideline


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