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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.
Young Sup Woo,Jung Wan Hong,Se-Hoon Shim,Hyung Mo Sung,Jeong Seok Seo,Sung-Yong Park,Jung Goo Lee,Bo-Hyun Yoon,Won-Myong Bahk 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.4
Objective: Attention-deficit/hyperactivity disorder (ADHD) is prevalent in adults, and psychiatric comorbidities are common in adults with ADHD. We aimed to examine the prevalence of adult ADHD with several common psychiatric conditions in a community sample in Korea and the association between adult ADHD and risk of psychiatric comorbidities. Methods: This study used a cross-sectional survey design. We provided supplementary and optional self-report questionnaires, including the Korean version of the World Health Organization Adult ADHD Self-Report Scale (ASRS) short screening scale, Patient Health Questionnaire-9 for screening for depression, Alcohol Use Disorders Identification Test alcohol consumption questions, and the Korean version of the Mood Disorders Questionnaire, to Korean adults who visited one of six centers of a large private healthcare company for the National General Health Examination. Results: A total of 17,799 subjects included in this study, and 430 (2.4%) were positive on the ASRS screen. ADHD was significantly associated with the 19−30-year-old age group (odds ratio [OR] = 3.938), lower income (OR = 1.298), depression (OR = 11.563), and bipolar disorder (OR = 3.162). Conclusion: Adult ADHD was highly associated with depression and bipolar disorder, suggesting that clinicians should carefully evaluate and treat such psychiatric disorders in adults with ADHD symptoms.
Se-hoon Shim,Yong-Ku Kim,Young Hwangbo,Hee-jung Yoon,Ji Sun Kim,Youn Jung Lee,Young Sup Woo,Won-Myong Bahk 대한정신약물학회 2021 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.19 No.2
Objective: There are animal models associating dopamine dysfunction with behavioral impairments that model attention deficit hyperactivity disorder (ADHD). Erythropoietin (EPO) has trophic effects on dopaminergic neurons. The aim of this study was to examine the EPO plasma levels and determine whether there was any correlation between plasma EPO levels and clinical characteristics of ADHD. Methods: Plasma EPO levels were measured in 78 drug-naïve children with ADHD and in 81 healthy children. The severity of ADHD symptoms was determined by scores on the Korean ADHD Rating Scale (K-ARS) in ADHD children and healthy controls. Results: The difference between median plasma EPO levels in ADHD children and in healthy controls was not statisti-cally significant. Adjusting for age and sex, a linear regression analysis showed that inattention score was significantly higher in the second highest tertile of plasma EPO compared to those in the lowest tertile. Hyperactivity-impulsivity score was significantly higher in the highest tertile of plasma EPO compared to those in the lowest tertile. Moreover, total K-ARS scores were significantly higher in the second highest tertile of plasma EPO compared to those in the lowest tertile. Conclusion: These findings suggest that plasma EPO levels were related to some ADHD symptoms, which could be used in the monitoring of the disorder.
Korean Medication Algorithm Project for Bipolar Disorder 2018 (KMAP-BP 2018): Fourth Revision
Young Sup Woo,Won-Myong Bahk,Jung Goo Lee,Jong Hyun Jeong,Moon Doo Kim,Inki Sohn,Se-Hoon Shim,Duk-In Jon,Jeong Seok Seo,Kyung Joon Min,Won Kim,송후림,Bo-Hyun Yoon 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.4
Objective: The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was first published in 2002 through an expert consensus of opinion, and updated in 2006, 2010, and 2014. This study constitutes the fourth revision of the KMAP-BP. Methods: A 50-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of adult bipolar disorder and six items for pediatric bipolar disorder. The review committee included 84 Korean psychiatrists and 43 child and adolescent psychiatry experts. Results: The preferred first-step strategies for acute mania were the combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP), MS monotherapy, and AAP monotherapy. A combination of a MS and an AAP, and AAP monotherapy were preferred for psychotic mania. The first-step strategies for mild to moderate bipolar depression were monotherapy with MS, AAP, or lamotrigine (LMT), and the combination of a MS and an AAP or LMT, or a combination of an AAP and LMT. The combination of two among a MS, AAP, and LMT were preferred for non-psychotic severe depression. A combination of a MS and an AAP or the combination of an AAP with an antidepressant or LMT were the first-line options for psychotic severe depression. Conclusion: The recommendations of the KMAP-BP 2018 have changed from the previous version by reflecting recent developments in pharmacotherapy for bipolar disorder. KMAP-BP 2018 provides clinicians with a wealth of information regarding appropriate strategies for treating patients with bipolar disorder.
Se-hoon Shim,Young Sup Woo,Ji Sun Kim,In Soo Heo,Hee-jung Yoon,Hyung Mo Sung,Jonghun Lee,Won-Myong Bahk 대한정신약물학회 2022 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.20 No.1
Objective: This study aimed to compare the efficacy and safety of atomoxetine (ATX) and OROS methylphenidate (MPH) as adjunctive to selective serotonin reuptake inhibitors (SSRIs) in adults with attention-deficit hyperactivity disorder (ADHD) with comorbid partially responsive major depressive disorder (MDD). Methods: Sixty Korean adults with ADHD and comorbid partially responsive MDD were recruited in a 12-week, randomized, rater-blinded, active-controlled trial and were evenly randomized to ATX or OROS MPH treatment. Results: Depressive symptoms measured using the Hamilton Depression Rating Scale and Clinically Useful Depression Outcome Scale, and ADHD symptoms measured using the Adult ADHD Self-Report Scale, as well as the Clinical Global Impression-Severity, Clinical Global Impression-Improvement, and the Sheehan Disability Scale scores were significantly improved in both groups during the 12 weeks of treatment. The changes in all outcome measures during the 12-week treatment were not significantly different between the two groups (all p > 0.05). No serious adverse events were reported and there were no significant differences in systolic and diastolic blood pressure, pulse rate, weight, or body mass index between the ATX and MPH groups. Conclusion: Our findings suggest that ATX and MPH can be used as adjunctive treatments in adults with ADHD and comorbid partially responsive MDD. The efficacy and tolerability of ATX and MPH in adults with ADHD did not differ significantly. Further studies should be conducted to draw a definitive conclusion.
Se-Hoon Shim,Jong-Hun Lee,Jye-Heon Song,Beomwoo Nam,Bo-Hyun Yoon,Ha-young Jin,Hyung-Mo Sung,Jong Hyun Jeong,Sae-Heon Jang,Duk-In Jon,Young Sup Woo,Won-Myong Bahk 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.3
Objective: This study aimed to evaluate the validity and reliability of a Korean version of the Mood Disorder Questionnaire-Adolescent version (K-MDQ-A) as a screening instrument for bipolar disorders in adolescents. Methods: One hundred two adolescents with bipolar disorders and their parents were recruited from November 2014 to November 2016 at 7 training hospitals. One hundred six controls were recruited from each middle school in two cities of South Korea. The parent version of the original MDQ-A was translated into Korean. The parents of all participants completed the K-MDQ-A. The diagnoses of bipolar disorders were determined based on the Korean version of K-SADS-PL. The test-retest reliability with a 10-month interval was investigated in 33 bipolar adolescents. Results: K-MDQ-A yielded a sensitivity of 0.90 and a specificity of 0.92 when using a cut-off score of endorsement of 5 items, indicating that symptoms occurred in the same time period and caused moderate or serious problems. The internal consistency of the K-MDQ-A was good. The correlations between each item and the total score ranged from 0.40 to 0.76 and were all statistically significant. Factor analysis revealed 3 factors that explained 61.25% of the total variance. The mean total score was significantly higher in bipolar adolescents (7.29) than in controls (1.32). The Pearson correlation coefficient for the total test-retest score was 0.59 (p<0.001). Conclusion: The K-MDQ-A completed by parents showed the excellent validity and reliability and may be a useful screening tool for adolescents with bipolar disorders attending in- and outpatient psychiatric clinics.
Young Sup Woo,Won-Myong Bahk,Jeong Seok Seo,Young-Min Park,Won Kim,Jong-Hyun Jeong,Se-Hoon Shim,Jung Goo Lee,Seung-Ho Jang,Chan-Mo Yang,Sheng-Min Wang,Myung Hun Jung,Hyung Mo Sung,Il Han Choo,Bo-Hyun 대한정신약물학회 2022 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.20 No.1
The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) first was published in 2002, and has been revised four times, in 2006, 2012, 2017, and 2021. In this review, we compared recommendations from the recently revised KMAP-DD 2021 to four global clinical practice guidelines (CPGs) for depression published after 2010. The recommendations from the KMAP-DD 2021 were similar to those from other CPGs, although there were some differences. The KMAP-DD 2021 reflected social culture and the healthcare system in Korea and recent evidence about pharmacotherapy for depression, as did other recently published evidence-based guidelines. Despite some intrinsic limitations as an expert consensus-based guideline, the KMAP-DD 2021 can be helpful for Korean psychiatrists making decisions in clinical settings by complementing previously published evidence-based guidelines, especially for some clinical situations lacking evidence from rigorously designed clinical trials.
한국형 우울장애 약물치료 알고리듬 2021 (I) : 주요우울삽화의 치료 전략
우영섭(Young Sup Woo),박원명(Won-Myong Bahk),서정석(Jeong Seok Seo),박영민(Young-Min Park),김원(Won Kim),정종현(Jong-Hyun Jeong),심세훈(Se-Hoon Shim),이정구(Jung Goo Lee),장승호(Seung-Ho Jang),왕성민(Sheng-Min Wang),정명훈(Myung Hun 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3
Objectives The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) is a consensus-based medication guideline. To reflect advances in pharmacotherapy for depressive disorders, we have undertaken a fourth revision of the KMAP-DD. Methods The review committee for the new version of the KMAP-DD (KMAP-DD 2021) included 143 Korean psychiatrists with clinical experience in the field of depressive disorders. Each treatment strategy or treatment option was evaluated with an overall score of nine, and the treatment option was categorized into the three levels of recommendation of primary, secondary, and tertiary. Results The first-line pharmacotherapeutic strategy for mild to moderate major depressive episodes (MDE) was antidepressant (AD) monotherapy. For severe MDE without psychotic features, AD monotherapy or the combination of AD and atypical antipsychotics (AAP) was the first-line strategy. The combination of AD and AAP was recommended as the first-line for the MDE with psychotic features as well. When treatment response to initial AD monotherapy was insufficient, a combination of AAP or another AD was recommended. In the case of unsatisfactory response to initial treatment with an AD and AAP combination, switching to another AAP or adding another AD was recommended. Conclusion Generally, there were no significant changes in the recommendations for MDE management in the KMAP-DD 2021 compared to previous versions. However, it was notable that the preference for the use of AAP and AD with the novel mechanism of action including vortioxetine and agomelatine increased.
한국형 우울장애 약물치료 알고리듬 2021 (II) : 임상 아형
박영민(Young-Min Park),서정석(Jeong Seok Seo),우영섭(Young Sup Woo),박원명(Won-Myong Bahk),김원(Won Kim),정종현(Jong-Hyun Jeong),심세훈(Se-Hoon Shim),이정구(Jung Goo Lee),장승호(Seung-Ho Jang),왕성민(Sheng-Min Wang),정명훈(Myung Hun 대한신경정신의학회 2021 신경정신의학 Vol.60 No.3
Objectives The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was developed in 2002 and revised in 2006, 2012, 2017. In 2021, the fifth edition was published. This edition reflected new findings and the latest trends in the areas of pharmacological treatment. The aim of this study is to present strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2021. Methods Ninety-seven psychiatrists with clinical experience in depressive disorder were selected. The questionnaires for KMAP-DD 2021 were sent to participants via mail. KMAP-DD 2021 consists of overall treatment strategies and treatment options under specific circumstances. Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into the three phases of recommendation that include primary, secondary, and tertiary. Results For persisting depressive disorder, antidepressant monotherapy including selectiveserotonin reuptake inhibitor (SSRI) (escitalopram, fluoxetine, sertraline, paroxetine), serotoninnorepinephrine reuptake inhibitor (SNRI) (desvenlafaxine, venlafaxine, duloxetine, milnacipran), vortioxetine, and mirtazapine, was recommended as first-line medications. For melancholia of major depressive disorder, SSRI, SNRI, vortioxetine, and mirtazapine also were recommended as first-line medications. For mixed features, SSRI, bupropion, mirtazapine, SNRI, except for duloxetine, and milnacipran were recommended as first-line medications. For anxious distress, SSRI, mirtazapine, and SNRI, except milnacipran, were recommended as first-line medications. Conclusion The preferences of antidepressants by experts differed according to the subtype of depression. These findings suggest that experts treat patients with a major depressive disorder after considering the subtype of depression involved.