My 19 year old step-son has been diagnosed with bipolar disorder and schizo-affective disorder. It is his second big episode in the last year.

He was on meds an doing fine but denied his condition and went off medication. He now is in a full blown manic episode and has been in the hospital for one week and then go out last week. The medication do not seem to help him and he complains of feeling unsafe to himself and others. He has delusional thinking even after four weeks of anti-psychotic drugs.

I live with him and am fearful for his life and mine as well. Is it normal not to have a decrease in delusions after four weeks of anti=psychotic drugs? What other possible diagnosis may apply? I wonder if he has multiple personality disorder as he is very focused on feeling sometimes like God, sometimes like the devil? he has very split thinking, black white, love, hate, anger, peace...He only has his father to take care of him and his father is burning out.

I feel that an in-treatment place could be helpful to him. The local hospital has not been much help except for medication. While in the hospital he acts on his best behavior so he can get out...but is not being truthful about his delusions and moods. Any suggestions? I am mostly afraid of him being dangerous and we won't know until something drastic happens. Thanks.

Thank you for your very important question. The first issue that is raised is called non- compliance. That is when the patient will not take their medication, and usually the patient will become ill again (manic or depressed. or a mixed state of the two, with what sounds like in your son's case, grandiose delusions of being God with alternating depressive delusions of being the devil). The psychotic symptoms (delusions are false beliefs and can include feelings of persecution from those that are often trying to help the patient) are common in bipolar disorder.

Schizo-affective disorder is a condition that is diagnosed in patients with significant symptoms of Schizophrenia (significant trouble thinking and caring for one's self even when your mood is apathetic or appearing calm) and significant symptoms of manic and depressive symptoms when ill, and/or a family history of schizophrenia or bipolar disorder). I do not think your son has multiple personality disorder, but rather his shifting mood, behavior and thinking is more like bipolar disorder.

Your safety is another issue that must be addressed by your son's health care team, and/or the police. My advice is to speak to your son's treatment team about your fears and concerns, as often the family can help patients comply with treatment. If you feel in immediate danger, please call the police first or protect yourself as best you can. I only hope your son settles soon, engages with the people trying to help him and allows your fears to diminish. I hope this helps. Thanks again.