Brain & Behavior Research Foundation

Previous studies have revealed that accurately diagnosing bipolar disorder takes a long time, often more than 10 years.1-3 Therefore, patients often experience significant financial, social, and health burden as a result of lack of appropriate treatment for bipolar disorder.1, 2 This has led to several bipolar awareness-raising activities, such as establishing a World Bipolar Day in 2014. In Japan, the Bipolar Disorders Committee was established at the Japanese Society of Mood Disorders in 2007, and since then, a bipolar disorder symposium has been held yearly. Moreover, the freely accessible guidelines for the treatment of bipolar disorder were established in 2011 and have been revised four times (https://www.secretariat.ne.jp/jsmd/iinkai/katsudou/data/guideline_sokyoku2020.pdf). And a leaflet explaining the symptoms and diagnoses of bipolar disorder, for the benefit of the public, has been released and revised nine times (https://www.secretariat.ne.jp/jsmd/gakkai/shiryo/data/bd_kaisetsu_ver9-20180730.pdf). The Japanese Alliance of Bipolar Disorder (the Nautilus Society) was established in 2010 as the first nonprofit and self-help organization in Japan. In this way, information has been constantly updated, and awareness-raising activities have been performed to make bipolar disorder more widely and accurately understood. However, it is unclear whether bipolar disorder is now more rapidly diagnosed than it was previously. This study aimed to investigate whether the period from onset to diagnosis of bipolar disorder has changed based on a questionnaire survey conducted among Nautilus members. The questionnaire was administered after the study had been approved by the Ethics Committee of the Nautilus Society, and only patients who consented to participate in the study were administered the questionnaire. The subjects included individuals who had been diagnosed with bipolar disorder by the attending psychiatrist, and the timing of onset and diagnosis was based on the patient's own self-report. The questionnaire was administered three times for different subjects: in 2015, 2016, and 2020. Of the total 249 respondents, 119 women (mean age, 46.88 years; SD, 12.33 years) and 100 men (mean age, 47.88 years; SD, 10.42 years) whose onset and diagnosis dates could be identified were included in the current analysis. All statistical analyses were performed using ezr.4 There was no significant difference in the period from onset to diagnosis depending on the year of diagnosis (Fig. 1). The periods from the onset to diagnosis (mean ± SD) in the first, second, and third questionnaires were 8.04 ± 8.17 years, 8.82 ± 8.24 years, and 6.36 ± 7.71 years, respectively, and no statistically significant difference was observed among them. Recently, using an Internet-based survey, Watanabe et al. reported that 24.3% of patients with bipolar disorder had been diagnosed at the first visit, and 34.4% and 64.6% of patients had been diagnosed within 1 and 5 years, respectively.2 In the current study, 8.4%, 13.3%, and 30.1% of patients had been diagnosed at the first visit and within 1 and 5 years, respectively. Although there were some numerical differences, probably due to the differences in methods between the Internet-based survey and the questionnaire survey of patient group members, these two studies reveal that there are still many patients in Japan whose diagnosis takes more than 5 years. Although the current study did not reveal the reason for the delay in the diagnosis of bipolar disorder, it has been pointed out that depression is the first condition to be diagnosed; patients do not usually consider manic states as illness and are prone to comorbidities.1-3, 5 This study has the following limitations. The subjects were members of the patient association; thus, there is a possibility that more severely sick people belong to the Nautilus Society. Moreover, the response rate was low, the sample size was small, and the time to diagnosis was determined by the patient's own memory. In conclusion, this study reveals that the diagnosis of bipolar disorder in many patients continues to be delayed despite various attempts in recent years. Further efforts are needed for the earlier diagnosis of bipolar disorder. We would like to thank Editage (www.editage.com) for English-language editing. The authors declare no conflict of interest.

Electroconvulsive therapy (ECT) continues to be an effective treatment option for patients who fail to respond to pharmacological interventions, are unable to tolerate medications, and show a suboptimal response to behavioral and psychotherapeutic treatments. However, risks for cognitive impairment may contribute to some patients' refusal of ECT. The present study examined galantamine as a pharmacological intervention to reduce cognitive adverse effects from ECT. Thirty-nine inpatients diagnosed with major depressive disorder; bipolar disorder, depressed type; or schizoaffective disorder, depressed type and admitted for ECT were randomized to galantamine or placebo. Study drugs were initiated 24 to 48 hours before starting ECT and continued throughout the course of ECT. A neuropsychological test battery was administered at baseline and 24 to 48 hours after completing a course of ECT treatments. Depression severity was monitored using the 17-item Hamilton Rating Scale for Depression and Clinical Global Impression Scale at baseline, weekly, and end point. Self-rated adverse effects were monitored weekly. Thirty participants (12 patients in the galantamine group, 18 patients in the placebo group) had both pretreatment and posttreatment neuropsychological ratings. Those in the galantamine group scored significantly higher at discharge for delayed memory (t28 = 2.44, P < 0.05). Hierarchical regressions examined if treatment condition predicted changes in delayed memory scores from baseline to discharge. Inclusion of the treatment condition in the final model made a significant incremental improvement in prediction (ΔR = 0.12, F1,27 change = 4.65, P < 0.05; β = 0.37, t = 2.16, P < 0.05). Galantamine was well tolerated with no clinically significant bradycardia or prolonged paralysis when administered with ECT. Galantamine may be protective against impairment in retention of new learning. Galantamine exhibited minimal adverse effects and was safe when administered during ECT. The present findings require replication by future researchers using larger samples before broad conclusions can be drawn.