Can be associated with atypical and severe course. Some believe that if onset of bipolar is that late, there may have been some "organic" factor, and in his case I would suspect that the heart condition involving a pacemaker had resulted in a clot causing a small, discrete stroke, probably in the right forebrain. Otherwise, I would expect that close questioning of the family would disclose the subtle presence of bipolar for many decades, going back even prior to the marriage.

The failures of "the System" are dreadfully familiar, massive numbers of errors of exclusion and inclusion. People talk civil liberties, but behind that is the thought, "We just can't go on paying for all this." Right now, public programs just don't have the capacity or the resources. The most effective period of my hospital's functioning was when the GA legislature was giving us just enough money to do a decent job and no more. That's an incredibly difficult balance to expect a stupid state legislature and a harried governor to manage.

My suggestion--- look for government programs that are working right, in other states and other countries, and learn from them. No junkets, just internet.