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I do believe that it can get worse if a bipolar patient refuses to see a psychiatrist and refuses all efforts at medication to assist with blood brain chemistry.
I think this is one reason it can get worse with age, but not the only one. No doubt plenty of people see their psychiatrists regularly and take their meds and despite their best efforts, their condition worsens. I suspect that more often than not, it is not the patient's 'fault' in this respect.
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