The rapid onset of a state of excitement and/or depression, often leads to a serious diagnostic blunder, confusing it with dementia: a serious mistake, since the wrong therapy will follow incorrect diagnosis, with inevitable reactions from the patient, who will feel handled in a custodial manner, badly understood and not believed, still being able to resort to his intact observational intelligence.
It’s easy to guess how vicious circles may arise, and sometimes have dramatic consequences.
It is not always easy and advisable to prescribe lithium, one of the most traditional medicines (often because of kidney problems, Irritable Bowel Syndrome, thyroid dysfunction).
We must bear in mind that, in an already fragile elderly patient, phases of intense emotional storm per se give origin to severe psycho-organic stress which may induce myocardial infarction; hypertensive strokes; neglecting to follow concomitant anti-diabetic therapies; traumas, accidents, and self-destructive behaviour.
Therefore it is necessary to follow a correct diagnosis with an adequate therapy, based on the patient’s ‘clinical measures’, calling for great attention from caregivers, since all bipolar disorders may modify, at times with great speed, requiring continuous adaptation of therapy.
Special attention should be paid to a patient in a ‘mixed phase’, when suffering simultaneously from symptoms of excitement and depression, which cause deeper emotional unrest.