DEAR DR. ROACH: Is it possible for a person to reach the age of 70 and just now be diagnosed with bipolar disorder? Are there degrees of impairment, like with autism — some worse than others? — C.S.
ANSWER: The hallmark of bipolar disease is mania. “Mania” has a specific meaning in psychiatry: It’s a very elevated mood, associated with high amounts of energy and an inability to think clearly, especially to see the consequences of one’s actions. Some common features of people in a manic episode include an inflated sense of self-worth, distractibility and racing ideas. People can be very talkative and feel little need to sleep. Dangerously, people in a manic phase can spend large amounts of money and have many sexual indiscretions.
All diseases have a spectrum of severity, and some are quite wide. With bipolar disease, 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 some “hypomanic” episodes: periods of high energy (and sometimes profound productivity), usually without the negative aspects of the “full” manic episode. Cyclothymia is a rapid cycling between hypomania and mild depression. There is a fourth type, “unspecified,” where people have abnormal mood elevations but don’t meet criteria for the other types.
Bipolar disease usually has its onset in early adulthood, but sometimes in teens or even childhood. However, I have rarely seen bipolar disease diagnosed in someone as old as 70. It isn’t always clear whether the disease is just manifesting that late, or whether it has been around for many years, but compensated for by the person. Some people don’t interact with a lot of family or friends, and manic or hypomanic episodes might be missed. It’s possible the 70-year-old in question has a quite mild form.
Treatment for bipolar disorder can dramatically improve the quality of life of the person and of the family and friends affected by the illness.
DEAR DR. ROACH: I have been diagnosed with vaginal atrophy. My primary doctor prescribed estrogen, which doesn’t seem to be helping after a year. I have also seen a woman’s doctor, who prescribed an antifungal, but this does not seem to be helping the symptoms. Do you have any suggestions as to what I should do? — Anon.
ANSWER: As a general rule, when appropriate therapy is not effective, it’s time to reconsider whether the initial diagnosis was correct. In this case, I would be concerned that the diagnosis of vaginal atrophy might be wrong, or might not be the only issue. I have received letters from women who were treated for atrophic vaginitis for years before the diagnosis of lichen sclerosis was made. Appropriate therapy for that diagnosis relieved the symptoms. When you go back to the woman’s doctor, I would ask about that diagnosis. A biopsy may be necessary to make that diagnosis. There are other less common causes as well.
Vaginal atrophy, when treated with estrogen, usually has noticeable improvement within a week or two. Fungal infection is possible (but should be apparent on exam), but it also gets better quickly. A year is too long to wait.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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