Does Post-traumatic Stress Disorder Impact Treatment Outcomes within a Randomised Controlled Trial of Mitochondrial Agents for Bipolar Depression?

Samantha E. Russell,Anna L. Wrobel,Melanie M. Ashton,Alyna Turner,Mohammadreza Mohebbi,MIchael Berk,Sue Cotton,Seetal Dodd,Chee H. Ng,Gin S. Malhi,Olivia M. Dean 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.3

Objective: Bipolar disorder often co-occurs with post-traumatic stress disorder, yet few studies have investigated the impact of post-traumatic stress disorder in bipolar disorder on treatment outcomes. The aim of this sub-analysis was to explore symptoms and functioning outcomes between those with bipolar disorder alone and those with comorbid bipolar disorder and post-traumatic stress disorder. Methods: Participants (n = 148) with bipolar depression were randomised to: (i) N-acetylcysteine alone; (ii) a combination of nutraceuticals; (iii) or placebo (in addition to treatment as usual) for 16 weeks (+4 weeks discontinuation). Differences between bipolar disorder and comorbid bipolar disorder and post-traumatic stress disorder on symptoms and functioning at five timepoints, as well as on the rate of change from baseline to week 16 and baseline to week 20, were examined. Results: There were no baseline differences between bipolar disorder alone and comorbid bipolar disorder and post-traumatic stress disorder apart from the bipolar disorder alone group being significantly more likely to be married (p = 0.01). There were also no significant differences between bipolar disorder alone and comorbid bipolar disorder and post-traumatic stress disorder on symptoms and functioning. Conclusion: There were no differences in clinical outcomes over time within the context of an adjunctive randomised controlled trial between those with bipolar disorder alone compared to those with comorbid bipolar disorder and post-traumatic stress disorder. However, differences in psychosocial factors may provide targets for areas of specific support for people with comorbid bipolar disorder and post-traumatic stress disorder.

Atypical Antipsychotics for Bipolar Disorder: Overblown or Blown Over?

Felicity Ng,Seetal Dodd,Michael Berk 대한정신약물학회 2007 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.5 No.2

Objective:Developments in the pharmacological treatment of bipolar disorder are of much interest, as the chronicity and disability of the disorder become better understood, and as treatment goals have shifted to emphasise early control of illness course and maintenance of euthymia in addition to acute episodic remission. Atypical antipsychotics have emerged as treatment options, and this paper aims to review the evidence for their role in bipolar disorder. Methods:A MEDLINE search was conducted for publications up till October 2006. Results:The search yielded a number of randomised, controlled clinical trials of various atypical antipsychotics as monotherapy or adjunctive therapy in bipolar disorder. The majority of such trials have investigated their efficacy in acute mania, with fewer studies devoted to acute bipolar depression or maintenance treatment. There are no specific trials on mixed states, which have mainly been studied together with bipolar mania. The most robust evidence supports a class effect of atypical agents in the treatment of mania. Conclusions:There are placebo-controlled trials that support the efficacy of olanzapine and quetiapine in bipolar depression, and of olanzapine and aripiprazole as maintenance treatment. There is strong support for the role of atypical antipsychotics in bipolar disorder management despite a relatively narrow literature base, chiefly for the treatment of mania. However, these findings need to be replicated, and further investigation is warranted to clarify their spectrum of efficacy in bipolar disorder. Objective:Developments in the pharmacological treatment of bipolar disorder are of much interest, as the chronicity and disability of the disorder become better understood, and as treatment goals have shifted to emphasise early control of illness course and maintenance of euthymia in addition to acute episodic remission. Atypical antipsychotics have emerged as treatment options, and this paper aims to review the evidence for their role in bipolar disorder. Methods:A MEDLINE search was conducted for publications up till October 2006. Results:The search yielded a number of randomised, controlled clinical trials of various atypical antipsychotics as monotherapy or adjunctive therapy in bipolar disorder. The majority of such trials have investigated their efficacy in acute mania, with fewer studies devoted to acute bipolar depression or maintenance treatment. There are no specific trials on mixed states, which have mainly been studied together with bipolar mania. The most robust evidence supports a class effect of atypical agents in the treatment of mania. Conclusions:There are placebo-controlled trials that support the efficacy of olanzapine and quetiapine in bipolar depression, and of olanzapine and aripiprazole as maintenance treatment. There is strong support for the role of atypical antipsychotics in bipolar disorder management despite a relatively narrow literature base, chiefly for the treatment of mania. However, these findings need to be replicated, and further investigation is warranted to clarify their spectrum of efficacy in bipolar disorder.

주요우울장애 환자에서 기분장애 질문지를 이용한 양극성 스펙트럼장애 선별에 관한 연구

김원우,권영준,심세훈,정희연,권완준,이화영 대한신경정신의학회 2012 신경정신의학 Vol.51 No.5

ObjectivesZZThis study was performed to evaluate the frequency of bipolar spectrum disorder (BSD) among patients who have been diagnosed with major depressive disorder. In addition, authors assessed the practical usefulness of the Mood Disorder Questionnaire (MDQ) to investigate the frequency of bipolar spectrum disorder in major depressive disorder. MethodsZZThe participants were 70 depressive patients who have never been diagnosed with bipolar disorders. The subjects were interviewed for diagnosis using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision criteria and the Mini-International Neuropsychiatric Interview to exclude bipolar disorders from the subjects. BSD criteria (as defined by Ghaemi, et al. 2002), and Korean version of the Mood Disorder Questionnaire (K-MDQ) was used to investigate their bipolarity. Data were collected including family history of affective disorder, number of previous depressive episode, age of onset, history of suicide attempt, comorbid psychiatric illness, and drug and alcohol use. ResultsZZAmong 70 subjects, 25 patients (35.7%) were classified as having bipolar spectrum disorder on BSD criteria, while other 45 patients (64.3%) as unipolar depression. Among the 25 patients who meet the BSD criteria, 24 patients (34.3%) scored more than 7 and only 1 patient (1.4%) scored less than 6 on K-MDQ. Among the 45 patients who don’t meet BSD criteria, 40 patients (57.1%) scored less than 6 and only 5 patients (7.1%) scored more than 7 on K-MDQ. Early age of onset, recurrent depressive episode, brief depressive episode, bipolar family history, history of suicide attempt, antidepressant induced hypomania, hyperthymic temperament, atypical depressive symptom, psychotic depressive symptom, and antidepressant “wear off” were found to be highly related with MDQ positive subjects and BSD subjects among the depressive subjects. ConclusionZZThe result of this study demonstrates the high frequency of BSD in depressive patients who have never been diagnosed with bipolar disorders. Some BSD criteria can be used to differentiate BSD subjects from the subjects with major depressive disorder. Also these results indicate that K-MDQ is useful for screening of bipolar spectrum disorder.

양극성 장애에도 정신치료가 필요한가? : 양극성 장애의 정신치료적 접근의 개요와 전망

김원 대한우울조울병학회 2011 우울조울병 Vol.9 No.3

Bipolar disorder is a severe and recurrent mood disorder. The proper pharmacotherapy is essential to the treatment of bipolar disorder. Then, how about psychotherapy? Is psychotherapy necessary to patients with bipolar disorder? The goal of this review is to present an overview of psychotherapy for bipolar disorder, updated results of clinical trial, and the implication of psychotherapy for bipolar disorder. There are several empirically supported psychotherapies for adjunctive treatment to pharmacotherapy of bipolar disorder. Cognitive-behavioral therapy (CBT), interpersonal social rhythm therapy (IPSRT), and Family-focused therapy (FFT) are well-organized branded psychotherapies and psychoeducation is one of the traditional methods for communicating with patients. With respect to the updated results of clinical trials, CBT is efficacious as adjunctive treatment to medication in acute depression and in preventing depressive episodes, but not clear in preventing manic episode. IPSRT is possibly efficacious as adjuncts to medication in acute depression and in preventing bipolar episodes. FFT is efficacious as adjuncts to medication in acute depression and in preventing both depressive and manic episodes. The psychotherapy for bipolar disorder is necessary to improve patients’ medication compliance, reduce residual symptoms, prevent relapse, and then restoring their life. Future research of psychotherapy for bipolar disorder will improve the treatment of bipolar disorder and patients’ qualities of life. (J of Kor Soc for Dep and Bip Disorders 2011;9:154-161)

양극성 장애 환자의 소아기 주의력결핍과 CHRNA7 유전자 다형성

정성훈,김의중,이규영,구영진,송주연,송혜진,이주은,주은정 대한정신약물학회 2011 대한정신약물학회지 Vol.22 No.4

Objective Patients with bipolar disorder have attention deficit during even euthymic status. Bipolar disorder patients showed more childhood attention deficit and other ADHD like feature. Alpha 7 nicotinic receptor (CHRNA7) gene has been known to play roles in attention and sensory gating, and association between CHRNA7 gene and bipolar disorder has been reported. Therefore, we investigated a possible association between childhood attention deficit of bipolar disorder and CHRNA7 gene polymorphisms. Methods We included 122 patients with bipolar disorder (89 subjects of bipolar disorder type I, 33 subjects of bipolar disorder type II). Childhood attention deficit was measured by Wender Utah Rating Scale (WURS). Factor analysis was done for WURS to extract inattention factor from childhood ADHD like feature. Three factors were extracted: Impulsivity, Inattention, and Mood instability. All subjects were ethnically Korean. Genotyping was done for three intronic Single Nucleotide Polymorphism (SNPs) of CHRNA7 gene: rs2337506 (A/G), rs6494223 (C/T), and rs12916879 (A/G). Analysis of association was done by UNPHASED version 3.1.4, a free software for genetic statistics. Results Genetic association tests found no association between factor score of inattention and any SNP or combination of SNPs of CHRNA7. Positive association between WURS total score and SNP rs6494223 (p=0.043), factor score of impulsivity and SNP rs2337506 (p=0.038) as well as SNP rs6494223 (p=0.043) was revealed. These positive associations were survived after 1,000 permutation tests. Combination of SNPs association tests performed for total WURS and factor scores could not find any significant association. Conclusion We could not find association between CHRNA7 gene and childhood attention deficit in bipolar disorder. However,we found CHRNA7 gene involved in childhood impulsivity of bipolar disorder, another ADHD like feature. Further studies with larger sample and denser polymorphisms are necessary to clarify genetic role of CHRNA7 in attention and impulsivity of bipolar disorder. 양극성 장애 환자에서 관찰되는 주의력저하에 대한 유전학적 탐구의 일환으로 본 연구에서는 양극성 장애 환자의 소아기 특성으로 나타나는 주의력결핍과 여러 측면에서 양극성 장애의 주의력과 관련이 깊을 것으로 보이는 후보유전자인 CHR-NA7 유전자와의 관련성을 살펴보았다. 122명의 DSM-IV 양극성 장애 환자(양극성 장애 1형 89명, 양극성 장애 2형 33명)를 대상으로 소아기 ADHD 특성을 조사하는 WURS를 적용하고 요인분석을 시행하여 주의력결핍, 충동성, 기분불안정의 3 가지 요인을 추출하였고 각각을 표현형으로 하여 CHRNA7 유전자 내 3개의 SNP 부위와의 관련성을 분석하였다. UNPHASED 를 이용한 개별 SNP 분석 및 SNP 들의 조합을 분석한 결과 소아기 주의력결핍과는 아무런 관련성을 찾을 수 없었고 소아기 충동성 특성에 대해서는 rs2337506와 rs6494223이 개별적으로 유의하게 관련됨을 발견할 수 있었다. 향후 CHRNA7 유전자의 양극성 장애 환자의 주의력 및 소아기 특성에 미치는 역할을 규명하기 위한 후속 연구들이 필요할 것으로 사료된다.

양극성 장애에 대한 현상학적 분석과 치료 - 임상, 상담심리학과 현상학적 방법 간의 학제 간 연구

이종주 한국현상학회 2018 철학과 현상학 연구 Vol.79 No.-

This paper aims to present the model of phenomenological analysis and treatment of bipolar disorder through interdisciplinary research between Husserls genetic phenomenology and recent studies since the 2000s on bipolar disorder, a representative mental disorder of modern society - BAS extension models, integrated cognitive models, positive emotional disorder models. First of all, by re-diagnosing depression as depression episode of bipolar disorder which Han Byung-chul diagnosed as the representative ills of modern society in Fatigue Society(2010), this paper reveals that bipolar disorder is a typical modern mental disorder that causes mood swings and energy exhaustion caused by performance-oriented life, self-centered life, pleasure, happiness-seeking life, and ostentatious activity-seeking life. Second, Criticizing Han Byung-chul’s sociological approach to bipolar disorder, traditional diagnosis and analysis methods - psychoanalysis, cognitive behavioral therapy, and biologym, this paper proposes a dialogue between phenomenology and new approaches to bipolar disorder since the 2000s - BAS extension models, integrated cognitive models, positive emotional disorder models. we argue that the analytic ways of constitutions of self, object and word in phenomenology, the phenomenological methods - epoche, phenomenological reduction and intuition of essence - , especially demolishing and building as methods of genetic phenomenology and three ways of experience of others in intersubjective genetic phenomenology - attachment, empathy and communication - have very important implications in analysis and cure of bipolar disorder. Third, the advantages and disadvantages of research results since 2000 are actually compared with Richard Lazarus’s circular model of synchronization : motivation → triggering event → cognitive assessment → emotional response → coping. Fourth, the research results of the three models are integrated into the world-constitution, object-constitution, cognitive-emotional constitution and practical constitution from the perspective of genetic phenomenology. Fifth, we explore the problems of object-world constitution, cognitive-emotional constitution and practical constitution of bipolar disorder through epoche, reduction of phenomenology as representative methods of phenomenology and seek the method of treatment of bipolar disorder. Finally, Quantitative and qualitative verification of the effectiveness of the treatment model are proposed. 본 논문은 현대사회의 대표적인 정신질환인 양극성장애에 대한 2000년대 이후 최근 연구들- 행동 활성화 시스템(BAS) 확장모델, 통합적 인지모델, 긍정적 정서장애 모델- 과 후설의 발생적 현상학의 학제 간 연구를 통해서 양극성장애에 대한 현상학적 분석과 치료의 모델을 제시하고자 한다. 먼저 한병철의 『 피로사회』(2010)에서 현대사회의 병리로 문제 삼고 있는 우울증을 양극성 장애의 우울에피소드로 재진단함으로써 양극성 장애가 성과위주의 삶, 자기본위의삶, 쾌락, 행복추구적 삶, 과시적 활동추구적 삶으로 인한 기분기복과 에너지 소진을 유발하는 대표적인 현대적 정신장애임을 밝힌다. 두 번째로 양극성 장애에대한 한병철의 사회병리학적 접근 및 전통적인 진단, 치료법-정신분석, 인지행동치료, 생물학주의-의 일면성을 지적하면서, 2000년대 이후 양극성 장애에 대한새로운 접근들- 행동 활성화 체계화(BAS)의 확장모델, 통합적 인지모델, 긍정적정서장애 모델 - 과 현상학의 대화를 제안해본다. 특히 현상학의 자기, 대상, 세계구성의 분석방식, 현상학적 방법 - 판단중지, 현상학적 환원 그리고 본질직관 - 과 특히 발생적 현상학적 방법인 헐어내기와 쌓아가기의 방법 그리고 발생적 상호주관성의 현상학에서 밝히고 있는 세 가지 타자경험의 방식-애착, 공감, 소통- 이 양극성 장애의 분석과 치유에서 갖는 함의를 밝힌다. 세 번째로 실제로 2000 년 이후의 연구성과의 장단점을 리처드 라자루스의 “동기→촉발사건→인지적평가→정서적 반응→대처행위”의 순환모델을 준거점으로 삼아 비교 검토한다. 네 번째로 세 가지 모델의 연구성과를 발생적 현상학의 관점에서 세계구성과 대상구성, 인지적-정서적 구성, 실천적 구성으로 통합한다. 다섯 번째로 발생적 현상학의 핵심방법론인 판단중지와 현상학적 환원을 중심으로 치료자와 내담자의관계 속에서 양극성 장애의 세계-대상구성과 인지적-정서적 구성, 실천적 구성의문제와 치료법을 모색한다. 마지막으로 양극성 장애에 대한 현상학적 분석과 치료모델의 효과성에 대한 양적, 질적 검증의 방안을 제시한다.

조기 발병 양극성 장애 환자의 임상적 특징 : 후향적 의무기록 조사 연구

우영섭,박민현,서호준,채정호,전태연,박원명 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.5

Objective : Bipolar disorder is a disease with diverse clinical profiles and outcomes. In recent years, it is suggested that if bipolar disorder occurs early in one's life, functional and symptomatic prognoses are poor. The prognoses include severe Symp-toms, frequent psychotic symptoms, comorbidity ofmental illnesses, slow improvement of the symptoms, and high suicide rate. We investigated the clinical characteristics of early onset bipolar inpatients. Method : The subjects of this study were selected from the patients who were discharged after hospitalization between January 1, 2001 and May 31, 2005 and diagnosed with bipolar disorder according to DSM-IV criteria. These patients were examined for the following data ; the type of bipolar disorder, comorbid psychiatric disorders, the age at onset of the illness, the acuteness of the disorder, and the duration of the disorder. The presence of four major clinical psychopathology, rapid cycling, Psychotic symptoms, comorbid psychiatric disorders, and suicide attempt, was also examined. The patients whose onset of the illness was before the age of 19 were classified as the early onset group and after the age of 19 were classified as the late onset group. Data on demographics, family histories, four major clinical psychopathologies and other clinical variables were compared between the early onset group and the late onset group. Results : Of the 53 patients, 19 patients belonged to the early onset group. There was higher incidence ofpsychotic Symp-toms in the early onset group than in the late onset group, and the difference was statistically significant according to the χ² - test (84.2% vs 44.1%, P=0.005). The incidence of comorbid psychiatric disorders was higher in the early onset group than in the late onset group, and the difference was also statistically significant according to the χ²-test (52.6% vs 23.5%, P=0.032).However, there was no statistically significant difFerence between the groups regarding the incidence of rapid cycling and suicide attempt. The result of logistics regression showed correlation of psychotic symptoms (0R=6.756 ; 1.655≤95% CI≤27.580) and comorbid psychiatric disorders (0R=3.611 ; 1.088≤95% CI≤11.984) with the early onset group. Conclusion : Early onset of bipolar disorder is related to the manifestation of psychotic symptoms and frequently accom-panies comorbid psychiatric disorders. The results of this study will help understand the mechanism of the onset of complexbipolar disorder and estimate the prognosis.

한국형 양극성 장애 약물치료 알고리듬 2010 : 유지치료

이정구,박원명,윤보현,전덕인,김원,서정석,민경준,이은,주연호,안용민,김병수,신영철 대한우울조울병학회 2011 우울조울병 Vol.9 No.3

Objective : After announcement of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2006, there has been an increasing need for the revision of treatment algorithm due to rapid changes in the management for bipolar disorder. In this study, we evaluated the maintenance treatment of bipolar I and bipolar II disorders of KMAP-BP 2010. Method : The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 65 experienced psychiatrists. It is composed of 37 questions, and each question includes various sub-items. We classified the expert opinion to 3 categories (the first-line treatment, the second-line, the third-line) by χ2 test. A part of this revision regarding maintenance treatment had 7 items ; 5 on bipolar I and 2 on bipolar II disorder. Results : In case of bipolar I disorder, mood stabilizer monotherapy and combination of mood stabilizer and atypical antipsychotic drugs were 1st-line treatment. In maintenance management for bipolar II disorder, two treatment options were recommended. Treatment with MS alone or combinations of MS and atypical antipsychotic drugs were preferred. Atypical antipsychotic drugs and lamotrigine were more favored in the maintenance treatment for bipolar I and II disorders than previous KAMP-BP 2006. Conclusions : There have been growing body of tendency that atypical antipsychotics are more preferred than the previous KMAP-BP. Also there is an increasing interest on the maintenance use of lamotrigine in the maintenance treatment of bipolar disorder. (J of Kor Soc for Dep and Bip Disorders 2011;9:162-170)

The Neurobiology of Bipolar Disorder: An Integrated Approach

Ather Muneer 전남대학교 의과학연구소 2016 전남의대학술지 Vol.52 No.1

Bipolar disorder is a heterogeneous condition with myriad clinical manifestations andmany comorbidities leading to severe disabilities in the biopsychosocial realm. The objectiveof this review article was to underline recent advances in knowledge regardingthe neurobiology of bipolar disorder. A further aim was to draw attention to new therapeutictargets in the treatment of bipolar disorder. To accomplish these goals, an electronicsearch was undertaken of the PubMed database in August 2015 of literature publishedduring the last 10 years on the pathophysiology of bipolar disorder. A wide-rangingevaluation of the existing work was done with search terms such as “mood disordersand biology,” “bipolar disorder and HPA axis,” “bipolar disorder and cytokines,” “mooddisorders and circadian rhythm,” “bipolar disorder and oxidative stress,” etc. This endeavorshowed that bipolar disorder is a diverse condition sharing neurobiologicalmechanisms with major depressive disorder and psychotic spectrum disorders. Thereis convincing evidence of crosstalk between different biological systems that act in adeleterious manner causing expression of the disease in genetically predisposedindividuals. Inflammatory mediators act in concert with oxidative stress to dysregulatehormonal, metabolic, and circadian homeostasis in precipitating and perpetuating theillness. Stress, whether biologically or psychologically mediated, is responsible for theinitiation and progression of the diathesis. Bipolar spectrum disorders have a stronggenetic component; severe life stresses acting through various paths cause the illnessphenotype.

한국형 양극성 장애 약물치료 알고리듬 2010: 다른 치료 지침들과의 비교

윤보현,박원명,민경준,김원,김병수,이정구,주연호,서정석,이은,안용민,신영철,우영섭,배승오,전덕인 대한정신약물학회 2011 대한정신약물학회지 Vol.22 No.4

Objective The Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002 and thereafter revised in 2006. It was secondly revised in 2010 (KMAP-BP 2010). The aim of this study was to compare KMAP-BP 2010 with other recently published treatment algorithm and guidelines for bipolar disorder. Methods The authors reviewed the 4 recently published guidelines and treatment algorithms for bipolar disorder [The British Association for Psychopharmacology Guideline for Treatment of Bipolar Disorder, Canadian Network for Mood and Anxiety Treatments Guidelines for the Management of Patients with Bipolar Disorder, The World Federation Society of Biological Psychiatry Guideline for Biological Treatment of Bipolar Disorder and National Institute for Health and Clinical Experience (NICE) Clinical Guideline] to compare the similarities and discrepancies between KMAP-BP 2010 and the others. Results In aspects of treatment options, most treatment guidelines had some similarities. But there were notable discrepancies between the recommendations of other guidelines and those of KMAP-BP in which combination or adjunctive treatments were favored. Most guidelines advocated new atypical antipsychotics as first-line treatment option in nearly all phases of bipolar disorder and lamotrigine in depressive phase and maintenance phase. Lithium and valproic acid were still commonly used as mood stabilizers in manic phase and strongly recommended valproic acid in mixed or psychotic mania. Mood stabilizers or atypical antipsychotics were selected as first-line treatment option in maintenance treatment. As the more evidences were accumulated,more use of atypical antipsychotics such as quetiapine, aripiprazole and ziprasidone were prominent. Conclusion This review suggests that the medication strategies of bipolar disorder have been reflected the recent studies and clinical experiences, and the consultation of treatment guidelines may provide clinicians with useful information and a rationale for making sequential treatment decisions. It also has been consistently stressed that treatment algorithm or guidelines are not a substitute for clinical judgment; they may serve as a critical reference to complement of individual clinical judgment. KMAP-BP 2010은 전반적으로 외국의 다른 치료 지침들과 일치하는 경우가 대부분이었다. KMAP-BP 2010에서는 다른 치료 지침들과는 달리 급성 조증의 초기 치료에서 기분조절제와 비정형 항정신병약물 병합치료를 1차적으로 권고하였고 양극성 우울증의 경우 다른 치료 지침들과 유사하게 중등도의 우울증에서는 기분조절제 단독치료 혹은 quetiapine이나 lamotrigine을, 중증 및 정신병적 우울증의 경우에는 기분조절제와 항우울제 병합 또는 기분조절제와 비정형 항정신병약물, 비정형 항정신병약물과 항우울제의 병합치료를 권고하였다. 유지치료 중 양극성 장애 I형의 경우 역시 기분조절제 또는 비정형 항정신병약물의 단독치료뿐 아니라 기분조절제, 특히 lamotrigine과 비정형 항정신병약물의 병합치료를 권고한 다는 점에서 치료 지침들 사이에 큰 차이가 없었으며 급속 순환에 있어서는 각 지침들 간에 명확한 일치점은 없었다. KMAP-BP 2010은 전반적으로 다른 치료 지침에 비해 병합치료를 선호하는 경향이 있었다.