한국형 양극성 장애 약물치료 알고리듬 2026: 총론

초록

Objectives Treatment guidelines or algorithms can assist clinicians in improving practice and clinical decision-making. Therefore, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) has been revised again through the experts’ consensus on the pharmacotherapy of bipolar disorder. Methods The previous KMAP-BP 2022 questionnaire was revised, and a survey was conducted for expert clinicians. Of 90 members of the review committee, 67 completed the survey. This study analyzed the answers, discussed the data, and held a clinician hearing. Results The preferred first-step strategies for acute non-psychotic mania are a combination of mood stabilizer (MS) and atypical antipsychotics (AAP), MS monotherapy, and AAP monotherapy. For psychotic mania, a combination of MS and AAP, and AAP monotherapy are preferred. For hypomania, MS monotherapy, AAP monotherapy, and a combination of MS and AAP are preferred. The first-step strategies for mild to moderate bipolar depression are MS monotherapy, lamotrigine (LMT) monotherapy, AAP monotherapy, MS+AAP combination, AAP+LMT combination, and MS+LMT combination. For non-psychotic severe depression, AAP monotherapy, MS+AAP combination, AAP+LMT combination, and MS+LMT combination are preferred. MS+AAP, AAP monotherapy, and AAP+LMT are preferred for severe psychotic depression. Conclusion The expert consensus and the developed KMAP-BP 2026 were surveyed. Compared with the previous KMAP-BP 2022, the clinicians’ preferences and decisions in real clinical situations could be determined more clearly. The preference for AAP is increased, and that of MS and antidepressants is decreased. This KMAP-BP 2026 is expected to be helpful for clinicians to treat patients with bipolar disorder.

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