Concluded Case

Late onset mania

One discussion of old age bipolar disorder with on Rx anti hypertension and anti diabetic MILD grade, patients with complains are insomnia euphoric mood talk active. How mangage him..? On examination his walking with support of stick. Total duration 3 year.

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Concluded answer

Imaging is definitely indicated before any other additional treatment. Yes But detail history taking and rapport need to be created for future possible Psychotherapy.

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Hi Doc History suggests old age male with abnormal behavior/ ? Manic episode since 3 yrs. Patient suffers from HTN and DM Is it episodic or continuous behavior pattern Any cognitive impairment. Manic behavior R/o organic cause Vascular dementia Plan: admit patient for stabilization.. CT scan brain and other routine bloods. Low dose of quetiapine, start with 25 mg and titrate for insomnia and elevated behavior. Lorazepam 0.5 mg as needed (for aggression or agitation. Do MMSE/ MOCA for memory

Thank you doctor
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what does this total duration of 3 years indicate? an average manic episode lasts approximately 3-6months...if it is continuous and onset is late an imaging is important to rule out organicity particularly with comorbidities like DM and HTN.

Last three year continuous...this type symptoms.
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Imaging is definitely indicated before any other additional treatment. Yes But detail history taking and rapport need to be created for future possible Psychotherapy.

Patient was came alone...no other significant history given by him...so i will discussion about elderly patients how mange this type of situation...
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Please write clearly. Not comprehensible.

What additional advise...?
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कम डोज मे लगभग वही दवा दें जो जवान मरीज को दी जाती है। मगर एम आर आई ब्रेन जरूर करा लें। इस ऐज मे प्रायः सेरिब्रल एट्रोफी होता है जिसमे सरेब्रोप्रोटिन थोड़ा अच्छा काम करता है। इसके साथ साथ सिटीकोलिन और पैरासिटाम और बी12 15 पावर भी अच्छा काम करता है। डोनेपाजील 5-10 भी देना अच्छा रहेगा

Reliability of history given by pt ???. Detailed history is needed by infomant to chalk out Rx plan . Being diabetic Level of blood sugar n current medication. Measurement of bp n medication.

Thank you doctor
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