A 56-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for the various phases of
bipolar disorder and for special populations. The review committee included 110 Korean psychiatrists and 38 experts for child and adolescent psychiatry. Of the committee members, 64 general psychiatrists and 23 child and adolescent psychiatrists responded to the survey.
RESULTS: The treatment of choice (TOC) for euphoric, mixed, and psychotic
mania was the combination of a mood stabilizer (MS) and an atypical
antipsychotic (
AAP); the TOC for acute mild depression was monotherapy with MS or
AAP; and the TOC for moderate or severe depression was MS plus
AAP/
antidepressant. The first-line maintenance treatment following
mania or depression was MS monotherapy or MS plus
AAP; the first-line treatment after
mania was
AAP monotherapy; and the first-line treatment after depression was
lamotrigine (LTG) monotherapy, LTG plus MS/
AAP, or MS plus
AAP plus LTG. The first-line treatment strategy for
mania in children and adolescents was MS plus
AAP or
AAP monotherapy. For geriatric bipolar patients, the TOC for
mania was
AAP/MS monotherapy, and the TOC for depression was
AAP plus MS or
AAP monotherapy.
CONCLUSION: The expert consensus in the KMAP-BP 2014 differed from that in previous publications; most notably, the preference for
AAP was increased in the treatment of acute
mania, depression, and maintenance treatment. There was increased expert preference for the use of
AAP and LTG. The major limitation of the present study is that it was based on the consensus of Korean experts rather than on experimental evidence.