Presentation Information
[P-36-06]Comparison of the treatment strategies of mixed features between bipolar disorder and major depressive disorder: data from Korean Medication Algorithm Project(KMAP) for Bipolar Disorder and Depressive Disorder
*JEONG SEOK SEO (Department of Psychiatry, College of Medicine, Chung-Ang University, Gwangmyeong Hospital, Gwangmyeong-si, Korea(Korea))
Keywords:
Bipolar disorder,KMAP-BP,Mixed features.,Pharmacotherapy
Objectives. Treatment guidelines or an algorithm can help clinicians implement better practices and clinical decisions. Therefore, the Korean Medication Algorithm Project for Bipolar Disorder and Depressive Disorder (KMAP-BP; KMAP-DD) have been regularly revised through a consensus of expert opinion almost every 4 years, since its first development in 2002. We compared the pharmacological strategies for mixed features in the perspective between bipolar disorder and major depressive disorder from the results of KMAP-BP 2022 and KMAP-DD 2018.Methods We revised the KMAP-BP and -DD with an updated questionnaire and conducted a survey with expert clinicians in mood disorder in Korea. Eighty-seven members of the review committee completed the survey in KMAP BP 2022, one hundred forty-three experts reviewed in KMAD-DD 2021. Each treatment strategy or treatment option was statistically calculated with 95% confidence interval, and the treatment option was categorized into the three levels of recommendation of primary, secondary, and tertiary depending on the low value of 95% CI. Treatment of choice (TOC) refers to an item that more than half of the reviewers gave 9 points. Results. A. In first-step strategies for manic episode with mixed features (KMAP-BP 2022) For manic-dominant mixed features, a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP) is the TOC. And MS monotherapy and AAP monotherapy are preferred strategies. For depressive symptom-dominant mixed features, a combination of MS + AAP, a combination of AAP + lamotrigine (LMT), AAP monotherapy, a combination of MS + LMT, and MS monotherapy were preferred. For mixed features with similar manic symptoms and depressive symptoms, a combination of MS and AAP, AAP monotherapy, and MS monotherapy were preferred. For depressive episode with mixed features (KMAP-DD 2021), preferred strategies were antidepressant (AD) + AAP and AD + MS were recommended. Conclusion. The treatment strategy for the mixed features differed depending on whether it was diagnosed as bipolar disorder or depressive disorder. In addition, there were differences in treatment strategies depending on which symptoms were dominant among bipolar disorders.