Korean Medication Algorithm Project for Bipolar Disorder 2022, Fifth Revision: An Executive Summary

Young Sup Woo(Young Sup Woo),Won-Myong Bahk(Won-Myong Bahk),Jong-Hyun Jeong(Jong-Hyun Jeong),Jung Goo Lee(Jung Goo Lee),Won Kim(Won Kim),InKi Sohn(InKi Sohn),Sung-Yong Park(Sung-Yong Park),Se-Hoon Shi 대한정신약물학회 2022 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.20 No.4

Objective: We revised the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP), first published in 2002 and revised in 2006, 2010, 2014, and 2018, to reflect recent progress in the treatment of bipolar disorder. Methods: The questionnaires consisted of 56 items for adult patients and 7 items for child/adolescent patients, and were used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of bipolar disorder. The review committee included 87 Korean psychiatrists and 40 child and adolescent psychiatry experts. Results: For treatment of manic episodes, a combination of a mood stabilizer (MS) and atypical antipsychotics (AAP), or monotherapy with MS or AAP were recommended as first-line treatments. Combinations of MS and AAP, or AAP and lamotrigine (LMT) were recommended as first-line treatments for depressive episodes regardless of the severity. Monotherapy with MS, AAP, or LMT were also first-line treatments for mild to moderate depressive episodes. For mixed features, a combination of MS and AAP, or monotherapy with AAP or MS were recommended as first-line treatments, and a combination of AAP and LMT, or MS and LMT were the first-line treatments for depressive mixed state. Conclusion: The recommendations of the KMAP-BP 2022 have changed from the previous version, to reflect the evolution of the social culture and healthcare system in Korea and recent evidence regarding pharmacotherapy of bipolar disorder. The KMAP-BP 2022 provides clinicians with a wealth of information regarding appropriate strategies to treat patients with bipolar disorder.

Psychometric Properties of the Korean Version of Functioning Assessment Short Test in Bipolar Disorder

Hangoeunbi Kang(Hangoeunbi Kang),Bo-Hyun Yoon(Bo-Hyun Yoon),Won-Myong Bahk(Won-Myong Bahk),Young Sup Woo(Young Sup Woo),Won Kim(Won Kim),Jonghun Lee(Jonghun Lee),InKi Sohn(InKi Sohn),Sung-Yong Park(Su 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.1

Objective: The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients. This brief instrument includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST). Methods: A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted. Results: The internal consistency (Cronbach’s alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p < 0.001). The K-FAST exhibited significant correlations with GAF (r = −0.771), WHOQOL-BREF (r = −0.326), YMRS (r = 0.509) and BDRS (r = 0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed four factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI = 0.925; TLI = 0.912; RMSEA = 0.078). Conclusion: The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.

Korean Medication Algorithm Project for Bipolar Disorder 2022: Comparisons with Other Treatment Guidelines

Jong-Hyun Jeong(Jong-Hyun Jeong),Won-Myong Bahk(Won-Myong Bahk),Young Sup Woo(Young Sup Woo),Bo-Hyun Yoon(Bo-Hyun Yoon),Jung Goo Lee(Jung Goo Lee),Won Kim(Won Kim),InKi Sohn(InKi Sohn),Sung-Yong Park( 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.1

The objective of this study was to compare recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2022 (KMAP-BP 2022) with other recently published guidelines for treating bipolar disorder. We reviewed a total of six recently published global treatment guidelines and compared treatment recommendation of the KMAP-BP 2022 with those of other guidelines. For initial treatment of mania, there were no significant differences across treatment guidelines. All guidelines recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or a combination of an MS with an AAP as a first-line treatment strategy in a same degree for mania. However, the KMAP-BP 2022 recommended MS + AAP combination therapy for psychotic mania, mixed mania and psychotic depression as treatment of choice. Aripiprazole, quetiapine and olanzapine were the first-line AAPs for nearly all phases of bipolar disorder across guidelines. Some guideline suggested olanzapine is a second-line options during maintenance treatment, related to concern about long-term tolerability. Most guidelines advocated newer AAPs (asenapine, cariprazine, long-acting injectable risperidone, and aripiprazole once monthly) as first-line treatment options for all phases while lamotrigine was recommended for depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. KMAP-BP 2022 guidelines were similar to other guidelines, reflecting current changes in prescription patterns for bipolar disorder based on accumulated research data. Strong preference for combination therapy was characteristic of KMAP-BP 2022, predominantly in the treatment of psychotic mania, mixed mania and psychotic depression.

Early Surgery versus Watchful Waiting in Patients with Moderate Aortic Stenosis and Left Ventricular Systolic Dysfunction

Inki Moon,Minkwan Kim,Jae-Woong Choi,Jun-Bean Park,Ho-Young Hwang,Hyung-Kwan Kim,Yong Jin Kim,Kyung-Hwan Kim,Ki-Bong Kim,Dae-Won Sohn,Seung-Pyo Lee 대한심장학회 2020 Korean Circulation Journal Vol.50 No.9

Background and Objectives: Severe aortic stenosis (AS) with left ventricular systolic dysfunction (LVSD) is a class I indication for aortic valve replacement (AVR) but this recommendation is not well established in those at the stage of moderate AS. We investigate the clinical impact of AVR among patients with moderate AS and LVSD. Methods: From 2001 to 2017, we consecutively identified patients with moderate AS and LVSD, defined as aortic valve area 1.0–1.5 cm2 and left ventricular ejection fraction <50%. The primary outcome was all-cause death. The outcomes were compared between those who underwent early surgical AVR (within 2 years of index echocardiography) at the stage of moderate AS versus those who were followed medically without AVR at the outpatient clinic. Results: Among 255 patients (70.1±11.3 years, male 62%), 37 patients received early AVR. The early AVR group was younger than the medical observation group (63.1±7.9 vs. 71.3±11.4) with a lower prevalence of hypertension and chronic kidney disease. During a median 1.8-year follow up, 121 patients (47.5%) died, and the early AVR group showed a significantly lower all-cause death rate than the medical observation group (5.03PY vs. 18.80PY, p<0.001). After multivariable Cox-proportional hazard regression adjusting for age, sex, comorbidities, and laboratory data, early AVR at the stage of moderate AS significantly reduced the risk of death (hazard ratio, 0.43; 95% confidence interval 0.20–0.91; p=0.028). Conclusions: In patients with moderate AS and LVSD, AVR reduces the risk of all-cause death. A prospective randomized trial is warranted to confirm our findings.

스탠포드최면반응성척도를 이용한 최면감수성 연구

손인기,이광헌,박희관 동국대학교 경주대학 2000 東國論集 Vol.19 No.-

Objectives : We conducted this study to evaluate normative data of the Korean version of Stanford Hypnotic Susceptibility Scale, Form A (SHSS). Methods : SHSS was translated into Korean under the permissions of Andre M. Weitzenhoffer and Ernest R. Hilgard and administered to 63 subjects (25.7±6.2 yr). Results : 1) The mean score of SHSS-K was 6.9±3.4. 2) A comparison of scores by age, sex, and body mass index(BMI) showed no difference. 3) Mixed-handed subjects (mean score = 10.2±2.4, n=5) were more hypnotizable than right-handed (mean score = 6.4±3.2, n=44)(p<0.05). 4) The internal consistency of SHSS-K is Cronbach's α=0.84. 5) Some Koreans (mean score = 6.9±3.4) were more hypnotizable than some Americans (mean score = 5.2±3.2)(p<0.05). Conclusion : It was concluded that SHSS-K was relatively reliable in this preliminary study and some Koreans were more hypnotizable than some Americans. Eventually we intend to gather norms on other groups of populations.

기분장애 환자의 비만에 대한 약물치료

손인기,이규항,Sohn, Inki,Lee, Kyu-Hang 한국정신신체의학회 2014 정신신체의학 Vol.22 No.2

기분장애에서 과체중과 비만의 문제가 일반인구보다 더 심각하고, 심혈관 치명률의 증가와 무관하지 않기 때문에 비만에 대한 치료가 필수적이다. 일반적인 상황에서 비만에 대한 치료와 동일하게 생활습관교정과 같은 비약물치료가 선행되어야 한다. 이 같은 시도가 실패하는 경우에는 약물치료가 필요하다. 기분장애의 비만치료로 공식 승인된 약은 없다. 따라서 일반인구의 비만에 승인된 약을 처방하거나 여러 연구를 통해서 효과가 입증된 약을 처방하게 된다. 여러 치료 지침과 연구 등은 orlistat, metformin, topiramate와 bupropion 등이 효과적임을 지지한다. The prevalence of obesity and overweight is increasing in mood disorder, and it is connected to an increased cardiovascular mortality. Because of them, treatment for obesity may be an essential part of mood disorder treatment. Similar to the general population, non-pharmacological treatment such as correction of life habits should be considered first of all. If this approaches are fail, pharmacological treatment for obesity would be required as next step. Any drug for obesity is not approved officially in mood disorder. So approved drugs in general population, and drugs supported by several studies are prescribed in clinical settings. Several treatment guidelines for mood disorder and studies support that orlistat, metformin, topiramate and bupropion is effective and safe.

Blonanserin Augmentation of Atypical Antipsychotics in Patients with Schizophrenia-Who Benefits from Blonanserin Augmentation?: An Open-Label, Prospective, Multicenter Study

우영섭,박주언,Do-Hoon Kim,Inki Sohn,Tae Yeon Hwang,박영민,Duk-In Jon,정종현,박원명 대한신경정신의학회 2016 PSYCHIATRY INVESTIGATION Vol.13 No.4

ObjectiveaaThe purpose of this study was to investigate the efficacy and tolerability of atypical antipsychotics (AAPs) with augmentation by blonanserin in schizophrenic patients. MethodsaaA total of 100 patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP were recruited in this 12-week, open-label, non-comparative, multicenter study. Blonanserin was added to their existing AAP regimen, which was maintained during the study period. Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at weeks 2, 4, 8, and 12. Predictors for PANSS response (≥20% reduction) were investigated. ResultsaaThe PANSS total score was significantly decreased at 12 weeks of blonanserin augmentation (-21.0±18.1, F=105.849, p<0.001). Moreover, 51.0% of participants experienced a response at week 12. Premature discontinuation of blonanserin occurred in 17 patients (17.0%); 4 of these patients dropped out due to adverse events. The patients who benefited the most from blonanserin were those with severe symptoms despite a treatment with a higher dose of AAP. ConclusionaaBlonanserin augmentation could be an effective strategy for patients with schizophrenia who were partially or completely unresponsive to treatment with an AAP.

회복된 기억의 진위에 대한 논쟁

홍계현 ( Kye Hyunn Hong ),손인기 ( Inki Sohn ) 한국정신병리진단분류학회 2012 精神病理學 Vol.21 No.1

The recovery of forgotten memories, especially the recovery of memories of childhood abuse are important from a clinical point of view. However, there is controversy about its authenticity because of the seriousness of its impact. Many retrospective studies support the veracity of the memories, but studies themselves are defective. There are many case reports, but also the problem of not being able to prove its validity. There are also prospective studies to support this, but some are otherwise. Even the possibility of false memories syndrome, therapists argue that they should consider the traumatic experience and the uniqueness of memories of that. There are attempts to compromise this disagreement in rational way. Psychiatric Association and Psychological Society in the United States and the United Kingdom present different guidelines about recovered memories, especially that of childhood abuse. The authors reviewed this controversy and representative guidelines.

DA 11004, a synthetic IDPc inhibitor, inhibits the high fat high sucrose diet-induced obesity in C57BL/6 mice

Kim WonBae,Jeong MiYoung,Shin ChangYell,Sohn JinBup,Lee InKi,Son Miwon,Bae CheolJun,Byun JongSoo,Kim DongSung,Huh TaeLin,Yoo Moohi,Kim SoonHae 大韓藥學會 2003 大韓藥學會 總會 및 學術大會 Vol.2003 No.1

Patient’s Perspective on Psychiatric Drugs: A Multicenter Survey-Based Study

Seoyun Han,Sun-Young Kim,Young-Eun Jung,Won Kim,Jeong Seok Seo,Inki Sohn,Kwanghun Lee,Jong Hun Lee,Sang-Keun Chung,Sang-Yeol Lee,Jung Wan Hong,Bo-Hyun Yoon,Young Sup Woo,Changwoo Han,Jhin Goo Chang,Wo 대한신경정신의학회 2024 PSYCHIATRY INVESTIGATION Vol.21 No.1

Objective We aimed to identify the expectations and preferences for medication and medical decision-making in patients with major psychiatric disorders.Methods A survey was conducted among patients with major psychiatric disorders who visited psychiatric outpatient clinics at 15 hospitals between 2016 and 2018 in Korea. The survey consisted of 12 questions about demographic variables and opinions on their expectations for medication, important medical decision-makers, and preferred drug type. The most preferred value in each category in the total population was identified, and differences in the preference ratio of each item among the disease groups were compared.Results A total of 707 participants were surveyed. In the total population, patients reported high efficacy (44.01%±21.44%) as the main wish for medication, themselves (37.39%±22.57%) and a doctor (35.27%±22.88%) as the main decision makers, and tablet/capsule (36.16%±30.69%) as the preferred type of drug. In the depressive disorders group, the preference ratio of high efficacy was significantly lower, and the preference ratio of a small amount was significantly higher than that of the psychotic disorder and bipolar disorder groups. The preference ratio of a doctor as an important decision maker in the bipolar disorder group was higher compared to the other groups.Conclusion This study revealed the preference for medications and showed differences among patients with psychiatric disorders. Providing personalized medicine that considers a patient’s preference for the drug may contribute to the improvement of drug compliance and outcomes.