한국형 양극성 장애 약물치료 알고리듬 2026: 혼재성 양상

초록

Objectives The treatment guidelines or algorithms support evidence-based decision-making in bipolar disorder. The Korean Medication Algorithm for Bipolar Disorder 2026 (KMAP-BP 2026) was revised through expert consensus. Mood episodes with mixed features remain clinically challenging. This study summarizes the expert preferences and recommendations for the pharmacological treatment of mixed features in bipolar disorder. Methods The questionnaire used in KMAP-BP 2022 was revised and redistributed to expert clinicians. Of 150 review committee members, 109 completed the survey. The responses were analyzed and discussed in a consensus meeting. Results For mixed features with predominant manic symptoms, a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) was the first-step treatment of choice, while MS monotherapy and AAP monotherapy were also preferred options. For mixed features with predominant depressive symptoms, the preferred strategies included a combination of MS and AAP, a combination of AAP and lamotrigine (LMT), AAP monotherapy, MS monotherapy, and a combination of MS and LMT. For mixed features with a similar manic and depressive symptom burden, a combination of MS and AAP was the treatment of choice, and AAP monotherapy, MS monotherapy, and a combination of AAP and LMT were preferred. Conclusion Combination therapy with MS and AAP was most preferred, and the tendency to favor AAPs slightly more than MS was maintained or even strengthened. Lurasidone was newly added as a preferred option, particularly for mixed presentations with depressive symptoms in this revision. KMAP-BP 2026 reflects the broader use of diverse pharmacological strategies and newer agents for mixed features compared with KMAP-BP 2022.

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