Clin Psychopharmacol Neurosci 2019; 17(2): 155-169  
Korean Medication Algorithm for Bipolar Disorder 2018: Comparisons with Other Treatment Guidelines
Jong-Hyun Jeong1, Won-Myong Bahk1, Young Sup Woo1, Jung Goo Lee2,3, Moon-Doo Kim4, InKi Sohn5, Se-Hoon Shim6, Duk-In Jon7, Jeong Seok Seo8, Won Kim9, Hoo-Rim Song10, Kyung Joon Min11, Bo-Hyun Yoon12
1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 2Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University and Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan, 3Department of Health Science and Technology, Graduate School of Inje University, Busan, 4Department of Psychiatry, Jeju National University Hospital, Jeju, 5Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, 6Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, Cheonan, 7Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, 8Department of Psychiatry, School of Medicine, Konkuk University, Chungju, 9Department of Psychiatry, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, 10Department of Psychiatry, Myongji Hospital, Goyang, 11Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, 12Department of Psychiatry, Naju National Hospital, Naju, Korea
Correspondence to: Won-Myong Bahk, MD, PhD, Department of Psychiatry, Yeuido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea, Tel: +82-2-3779-1051, Fax: +82-2-780-6577, E-mail: wmbahk@catholic.ac.kr, ORCID: https://orcid.org/0000-0002-0156-2510
Received: July 23, 2018; Revised: July 30, 2018; Accepted: July 31, 2018; Published online: May 31, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018) with other recently published guidelines for treating bipolar disorder. We reviewed a total of five recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2018 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 for mania. However, the KMAP-BP 2018 did not prefer monotherapy with MS or AAP for psychotic mania. Quetiapine, olanzapine and aripiprazole were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Most guidelines advocated newer AAPs 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. As research evidence accumulated over time, recommendations of newer AAPs (such as asenapine, cariprazine, paliperidone, lurasidine, long-acting injectable risperidone and aripiprazole once monthly) became prominent. KMAP-BP 2018 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 2018, predominantly in the treatment of psychotic mania and severe depression. Further studies were needed to address several issues identified in our review.
Keywords: Bipolar disorder; Pharmacotherapy; Algorithm; Treatment guideline; Korean Medication Algorithm Project for Bipolar Disorder 2018.


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