한국형 양극성 장애 약물치료 알고리듬 2010: 다른 치료 지침들과의 비교

Abstract

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.

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.