Hello, I’m a 17-year-old boy. I was admitted into acute care for mania and self-harm after my father passed away. I was diagnosed with severe PTSD (not acute, because I’d been diagnosed in the past with it) and Bipolar 1 Disorder with Psychosis and Mixed Episodes. But I don’t think that’s the case, my psychosis isn’t only when I’m manic or depressed, it’s even when I’m stable. I’ll hear voices all the time, I’m almost always paranoid or delusional. But because I have some insight into this, I’ve been told I’m faking before. I don’t feel like I’m faking though, an example of a hallucination was I was checking my air conditioning vent and I saw a very vivid face in the vent, and I had a severe panic attack. I’ll hear voices calling my name all the time, or bells ringing, or children laughing at 2am. It’s horrifying and I don’t know what to do. Is this Schizoaffective? I even have the disorganised speech, it’s not very intense but I constantly have people asking me what I’m talking about because what I’m saying, even though it makes sense to me, doesn’t make sense to them. I know I have the major depressive episodes and the mania, but the psychosis doesn’t line up with it. I’m not always in a flux of either one or the other. Thank you for taking the time to read this.

A. If you were admitted into 10 different psychiatric emergency rooms and evaluated by 10 different physicians, you may receive 10 different psychiatric diagnoses. Diagnosis is not an exact science. That’s why many clinicians, myself included, believe that diagnosis is often less important than finding the right treatment.

Psychiatric diagnosis is especially difficult for youth. Adolescents are in the process of growing, developing and maturing. For that reason, many clinicians feel uncomfortable diagnosing adolescents with a mental illness.

Medication is the primary treatment for psychosis. You may need to try several medications to find what works best for you. Trial and error is a normal part of the treatment process. The fact that you are continuing to have symptoms, despite being in treatment, is concerning. It would suggest that adjustments are needed. Finding the best symptom improvement is where your focus should be.

Counseling should also be added to your treatment plan. It will help you learn alternative ways of coping with unpleasant and difficult emotions. The death of a parent is difficult for anyone, at any age. Counseling is the ideal place to safely grieve the loss of your father. It will also teach you better methods of coping so that you will be less inclined to engage in self-harm. People who engage in self-harm often do so because they lack psychologically healthy coping skills. Counseling can remedy many, if not all, of the problems you have described. I wish you the best of luck. Please take care.

Dr. Kristina Randle