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Korean Medication Algorithm for Bipolar Disorder: changes in preferred medications for mania over 20 years

Published online by Cambridge University Press:  27 August 2024

D.-I. Jon ,
Y. S. Woo ,
J.-H. Jeong ,
J.-S. Seo ,
J. G. Lee ,
B.-H. Yoon ,
I. Sohn  and
W.-M. Bahk
D.-I. Jon*
Affiliation:
1Hallym University Sacred Heart Hospital, Anyang
Y. S. Woo
Affiliation:
2The Catholic University
J.-H. Jeong
Affiliation:
2The Catholic University
J.-S. Seo
Affiliation:
3Joongang University, Seoul
J. G. Lee
Affiliation:
4Inje University, Busan
B.-H. Yoon
Affiliation:
5Naju National Hospital, Naju
I. Sohn
Affiliation:
6Kyeyo Hospital, Euwang, Korea, Republic Of
W.-M. Bahk
Affiliation:
2The Catholic University
*
*Corresponding author.

Abstract

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Introduction

Majority of international guidelines for bipolar disorders are based on evidences from clinical trials. In contrast, 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.

Objectives

In this study, preferred medication strategies for acute mania over six consecutively published KMAP-BP (2002, 2006, 2010, 2014, 2018, and 2022) were investigated.

Methods

A written survey using a nine-point scale was asked to Korean experts about the appropriateness of various treatment strategies and treatment agents. A written survey asked about the appropriateness of various treatment strategies and treatment agents commonly used by clinicians as the first-line.

Results

The most preferred option for the initial treatment of mania was a combination of a mood stabilizer (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. Either 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 where valproate is the most recommended MS. The preference of valproate showed reverse U-shaped curve. This preference change of valproate may indicate the concern about teratotoxicity in women. Quetiapine, aripiprazole, and olanzapine were the preferred AAP for acute mania since 2014. This change might depend on the recent evidences and safety profile. In cases of unsatisfactory response to initial medications, switching or adding another first-line agent was recommended. The most notable changes over time included the increasing preference for AAPs.

Conclusions

The Korean experts have been increasingly convinced of the effectiveness of a combination therapy for acute mania. There have been evident preference changes: increased for AAP and decreased for carbamazepine.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 67 , Special Issue S1: Abstracts of the 32nd European Congress of Psychiatry , April 2024 , pp. S251 - S252
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of European Psychiatric Association
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