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Hyperactive One Day And Very Quiet The Next Day, Fragile, Depressed. Is This Bipolar Disorder? Treatment?

Posted on Wed, 13 Jun 2012

Question: My grandmother has been exhibiting a strange behaviour for the past two and a half years (since one of her sons died ) .. E.g. She will be hyperactive one day (very talkative, physically too energetic) and immediately the next day she'll be very quiet, physically fragile, and slightly depressed. Again, the next day, she'll back to her hyperactivity and so on. I googled a little and am guessing that she is suffering from 'bipolar disorder' and that such a patient needs lithium dosages (please correct me if I'm wrong). Since she is in Allahabad (where no doctor has been able to understnd her problem), I request you to suggest a line of treatment which I can start for her in consultation with a general physician or a psychiatrist.

Answered by Dr. Ashish Mittal (9 hours later)

Hello,
Thanks for your query.

Important aspects of your query are:
•     85 year old female
•     Total illness duration 2.5 years
•     Concern related to bipolar disorder and its treatment

Your concerns are true. But classically, in bipolar disorder, each manic and depressive episode last for few days. There may be other problem.

Points against bipolar disorder in this case:
•     Age of onset after 80 years
•     Atypical presentation
•     Short duration of episodes

There are multiple possibilities in your case in order of preference from current information:
•     Organic psychosis
•     Dementia
•     Bipolar illness

As your grandmother is very old, so there is need to rule out dementia (present with short term memory loss). Dementia can also present with episodic hyperactivity.

Whenever bipolar disorder like symptom occurs in old age person we need to rule out organic (physical) cause of disorder. This need detailed history, physical examination and laboratory/imaging study. Old age people also need doses much lower than young age people. Drug doses depend on their physical condition, liver & kidney function status. For final diagnosis and management you need to visit psychiatrist with grand mom so that he can examine her and can take appropriate steps for treatment.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ashish Mittal (16 hours later)

Dear Sir,

Thanks a lot for your views..

I wish to know which specific tests you will recommend the most. Should I go for the tests mentioned in the following link: WWW.WWWW.WW (blood chemistries and cell count, drug and alcohol screen, brain computed tomography (CT) or magnetic resonance imaging (MRI), toxicological screen, electroencephalogram (EEG), and spinal tap (lumbar puncture))

Besides the tests of liver and kidney, do you think we should get a test of her thyroid secretion as well? Can that, or any other hormone, be related to her current problem?

Thanks and Regards
Shalini XXXXXXX

Answered by Dr. Ashish Mittal (7 hours later)

Hello XXXXXXX

Thank you for writing back.

She may need all the mentioned tests (except drug and alcohol screen, toxicological screen: if not suspected). Examination also help narrow down number of test need to perform on patient as a test may have adverse consequences. Like CT has radiation exposure and lumber puncture may lead to neurological infection in some patients.

Before any test, a detailed history and detailed physical and mental status examination is needed. Diagnosis depends more than 80% on patient history and examination findings.

So in current situation consultation with psychiatrist will help, so that he can perform appropriate examination after history and guide further tests which is needed in this case.

Wish her good health,

Regards.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ashish Mittal (5 hours later)

Thanks a lot Sir for your valuable help ....

Will get back in touch with you as I get all the check - up done...

Warm regards
Shalini XXXXXXX

Answered by Dr. Ashish Mittal (3 hours later)

Hello XXXXXXX
Thanks for the follow up.

I know it is very distressing having a family member ill. Hope my answers will help in management and speedy recovery of your grandmom.

Take care.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Radhika