한국형 양극성 장애 약물치료 알고리듬 2026: 조증 삽화

초록

Objectives The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) is an expert consensus–based guideline for the pharmacological treatment of bipolar disorder. In response to ongoing advances in treatment, the guidelines were revised to provide updated and clinically relevant recommendations. Methods A structured questionnaire on the pharmacological treatment of manic and hypomanic episodes was distributed to 90 review committee members, of whom 67 (74.4%) completed the survey. Each treatment strategy or option was rated on a nine-point scale. The options were classified as first-, second-, or third-line, based on the lower bound of the 95% confidence interval of the mean score. The executive committee finalized the algorithm after reviewing the statistical results and available scientific evidence. Results For mania without psychotic features, the first-line strategies included combination therapy with a mood stabilizer and an atypical antipsychotic, mood stabilizer monotherapy, and atypical antipsychotic monotherapy. For mania with psychotic features, combination therapy was the treatment of choice, and atypical antipsychotic monotherapy was also first-line. When the initial treatment was insufficient, switching to or adding another first-line agent was recommended, with an earlier transition to combination therapy after an inadequate response to monotherapy. Compared with the previous revision, risperidone received a higher recommendation level, and lurasidone was newly added as an alternative atypical antipsychotic. Atypical antipsychotic–based strategies were recommended more broadly across the treatment steps. For hypomania, mood stabilizer monotherapy, atypical antipsychotic monotherapy, and combination therapy were all recommended as first-line options. Conclusion The 2026 KMAP-BP revision maintains a stepwise treatment approach while reflecting updated clinical preferences and newly available medications.

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