DEAR DR. ROACH: Is it possible for a person to reach the age of 70 and be diagnosed with bipolar disorder? Are there degrees of impairment, as with autism, some worse than others? – CS
ANSWER: The hallmark of bipolar disease is mania. “Mania” has a special meaning in psychiatry: it is a very high mood, associated with large amounts of energy and an inability to think clearly, especially to see the consequences of one’s actions.
Some common characteristics of people in a manic episode include an exaggerated sense of self-worth, distraction, and racing ideas. People can be very talkative and have little need for sleep. Dangerously, people in the manic phase can spend large sums of money and have a lot of sexual indiscretions.
All diseases have a spectrum of severity, and some are quite broad. With bipolar disease in particular, however, there are four distinct forms of the disease. Bipolar I is the classic form, once called “manic-depressive illness,” where people have episodes of mania, alternating with periods of normal behavior or depression.
People with bipolar II have depressive episodes and a few “hypomanic” episodes: periods of high energy (and sometimes deep productivity), usually without the negatives of the “full” manic episode. Cyclothymia is a rapid cycle between hypomania and mild depression.
There is a fourth type, “unspecified”, where people have abnormal mood elevations but do not meet the criteria for other types. Bipolar disease usually appears in early adulthood, but sometimes in adolescence or even childhood.
However, I have rarely seen bipolar disease diagnosed in someone as old as 70 years old. It is not always clear whether the disease manifests itself this late or whether it has existed for many years, but is compensated by the person.
Some people don’t interact with many family members or friends, and manic or hypomanic episodes can be missed. It is possible that the 70-year-old man in question has a fairly light form. Treatment for bipolar disorder can dramatically improve the quality of life for the person, family and friends affected by the disease.
DEAR DR. GARDON: I was diagnosed with vaginal atrophy. My GP prescribed me estrogen, which doesn’t seem to help me after a year. I also saw a woman’s doctor who prescribed an antifungal medication for me, but it didn’t seem to relieve the symptoms. Do you have any suggestions on what to do? – Anon.
ANSWER: As a general rule, when appropriate treatment is not effective, it is time to reconsider whether the initial diagnosis was correct. In that case, I would be concerned that the diagnosis of vaginal atrophy was wrong or not the only problem.
I have received letters from women who were treated for atrophic vaginitis years before they were diagnosed with multiple sclerosis. Appropriate therapy for this diagnosis relieved the symptoms. When you return to see the woman’s doctor, I ask you about this diagnosis.
A biopsy may be needed to make this diagnosis. There are also other less common causes. Vaginal atrophy, when treated with estrogen, usually shows noticeable improvement within a week or two. A fungal infection is possible (but should be noticeable on examination), but it also gets better quickly. A year is too long to wait.