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- Title
Korean Medication Algorithm for Bipolar Disorder: Changes in Preferred Medications for Mania Over 20 years.
- Authors
Duk-In Jon; Young Sup Woo; Jong-Hyun Jeong; Jeong-Seok Seo; Jung Goo Lee; Bo-Hyun Yoon; Inki Sohn; Won-Myong Bahk
- Abstract
Many treatment guidelines for bipolar disorders have been published. Majority of these guidelines are based on the evidence from clinical trials. The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed to adopt an expert-consensus paradigm which was more practical and specific to the atmosphere in Korea. This study investigated preferred medication strategies for acute mania over five consecutively published KMAP-BP (2002, 2006, 2010, 2014, 2018, and 2022). The KMAP-BP questionnaire using a nine-point scale covered some specific clinical situations divided into subsections with many treatment options. A written survey asked about the appropriateness of various treatment strategies and treatment agents commonly used by clinicians as the first line. The most preferred option for the initial treatment of mania was a combination of a mood stabiliser (MS) and an atypical antipsychotic (AAP) in every edition. Preference for combined treatment for euphoric mania increased, peaked in KMAP-BP 2010, and declined slightly. MS or AAP monotherapy was also considered a first-line strategy for mania, but not for all types of episodes, including mixed/psychotic mania. Among MSs, lithium and valproate are almost equally preferred except in the mixed subtype, whereas valproate is the most recommended MS. The preference for valproate showed a reverse U-shaped curve. This preference change of valproate may indicate concern about teratotoxicity. Quetiapine, aripiprazole, and olanzapine were the preferred AAP for acute mania in later editions. This change might depend on the recent evidence and safety profile. The most notable changes over time included the increasing preference for AAPs. Korean experts have been increasingly convinced of the effectiveness of a combination therapy for acute mana. There have been evident preference changes: increased for AAP and decreased for carbamazepine.
- Subjects
SOUTH Korea; BIPOLAR disorder; MANIA; DRUGS; ALGORITHMS; VALPROIC acid
- Publication
Malaysian Journal of Medicine & Health Sciences, 2023, Vol 19, p140
- ISSN
1675-8544
- Publication type
Abstract