한국형 양극성 장애 약물치료 알고리듬 2014: 신체질환이 동반되었을 경우

Abstract

이번 KMAP-BP 2014에서는 신체질환을 동반한 양극성 장애의 약물치료 전략으로 aripiprazole의 선호도가 특히 증가되었음을 확인할 수 있었다. 당뇨, 심장질환, 신장질환, 간질환을 동반한 모두 경우에서 aripiprazole은 1차 약물로 선택되었다. 뇌졸중 혹은 두부 손상을 동반한 경우에는 valproate가 1차 약물로 선택되었다. 전기경련요법은 신체질환이 있는 경우 시행해 볼 수 있는 것으로 알려져 있으나 이번 결과에서는 선호도가 낮은 것으로 조사되었다.

Objective: The third revision of Korean Medication Algorithm Project for Bipolar Disorder was performed in 2014 in order to provide more proper guideline for clinicians. In this study, we undertook a survey of expert opinion to help clinical decisions in medical comorbidities. Methods: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 64 experienced psychiatrists. This survey was composed of 56 main questionnaires of which the contents covered from overall treatment strategies to treatment strategies under the specific situations. The executive committee analyzed the results and discussed the final production of algorithm. Results: In bipolar patients with cardiovascular, diabetic, or hepatic comorbidities, aripiprazole was first-line treatment strategy. In case of renal comorbidity accompanying bipolar disorder, aripiprazole, valproate, and quetiapine were preferred. Valproate was recommended as the first-line strategy in case of bipolar disorder with cerebrovascular diseases. Conclusion: This study provided information about the consensus among experts in regard to treatment strategies for bipolar disorder in the medically ill.