Now he is having major sleep disturbances...feeling tired no matter how much he sleeps, waking up many times in the night--last night he called me, sounding desperate--he had woken up six times in eight hours. He was exhausted and sounded drugged, couldn't function in any meaningful way.

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Is this board alive?

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This young man has been through a lot. No wonder he is having problems. At least he has someone he can trust so he is ahead there. It's sure sounds like he has some form of bipolar disorder. It's very common to have other conditions along with the bipolar however and since the symptoms overlap it takes an expert to sort it out. I'm not a doctor but it sounds like it would be best to have him evaluated asap. I'm predicting that what he needs most is a mood stabilizer like Lithium or other baseline medication for bipolar at the very least. He will probably need something else as well but just the mood stabilizer could help a lot. There are several subtypes of bipolar and also depending on what other diagnoses he gets that will help in the decision of what would be good choices for him. Anxiety, problems sleeping, agitition and all those other things you mentioned can be manifestations of bipolar mania which is just getting started. The best thing to do is to get him seen very soon before it continues into full blown mania. When this happens he will not be in a good place to make any decisions about what is good for him. Sometimes people with bipolar seem paranoid or see or hear things that aren't there or have delusions or strange ideas. It also effects their thought processes and memory so this makes it hard to function. They may be agitated and have trouble sitting still or paying attention (which sometimes gets them the diagnosis of ADHD when it's really bipolar). If it's bipolar then taking a stimulant is not ususally a good idea without a mood stabilizer in place first. Lots of time the "ADHD" gets better on bipolar meds. My daughter is bipolar and I have read lots of material on the subject but there is still so much they have to learn about this condition. Add in the horrible past your friend has had and the bad advice to avoid medical treatment and you have a real mess. There is hope though so do not let him give up. Get him to a therapist and keep him going, get him tested if you can do that (maybe the school can refer him), and get the appointment set up with the doctor. If he gets worse rapidly (has delusions, is acting depressed, agitated, not sleeping or is hostile or threatening) get him to an ER where they can assess him right away. Things can progress rapidly from bad to worse and unfortunately untreated bipolar disorder has a very high risk of suicide, especially in males. He needs meds for sure and if it takes an ER trip to a local hospital that has a psychiatric unit to get him started take him there. Sometimes you just can't wait to do all these appointments. You can still get them set up but do not think you have to wait to get him seen. I wish I had taken action sooner when my daughter had a major episode about 2 years ago. And I kind of wish I had had her hospitalized. Luckily she is fine now, but if she was off meds and acting like your friend I would get her to the hospital by hook or by crook. I would even call the police if she got as agitated as she did then again. I have heard that the agitation (pacing, rapid talking, not sleeping and so on) is the beginning of a major manic episode. Now I know but I didn't recognize it then. And I didn't realize that it would only get worse. I kept thinking well, it's a little better so maybe it's going away. Do you live somewhere there is a university affiliated hospital? I live near a University where there is a med school and a hospital associated with it. They have a psychiatric unit and they are used to dealing with patients with bipolar and other related disorders. They have to take Medicaid also because they are a state university facility. A state or public health district hospital has to take any patient regardless of their ability to pay. they can at least evaluate him and if you go and tell them you are very concerned for his safety (and yours or someone else's) they will have to deal with it. If he has been dangerous they can admit him even if he doesn't want to. If they don't think he is he can refuse treatment unfortunately. At least try to get him seen and started on something. I sure hope this helps. It's the best advice I can give, to take it seriously. It's a very serious condition and the most dangerous of all the other possible things he has. People do not die from ADD or Anxiety but they can die from bipolar mania by doing dangerous things or when they are in the depressive part by suicide. You are a good friend so maybe you are the one who can get him in to get treated now.

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It might be. Or it might be PTSD. Or both. I am certainly not an expert in bipolar disorder but I have seen some kids that definitely had it and he seems very different from them. Which is not to say that isn't what he has. But I am not ready to say that the psychiatrist he had at the shelter was right...they didn't even give him therapy. He is only now getting therapy. He has the first appointment with the psychiatrist this Friday at 2 p.m. I am preparing a letter of introduction to the psychiatrist to give him some background. The sleep disturbances could be a result of the ADHD, which he also had a diagnosis of when he was young. Right now he seems to be stable and I keep very close tabs with him. I talk to him on most days and communicate with him every day so that I can make sure he stays stable. While there is a house mother in the residence hall at school, she has a lot to deal with and she is friendly with him but is not close to him like I am. If I don't keep tabs on him, no one else will. I wish he was here because having him 6-7 hours away makes things that much harder. I can't just run up there to see him. I have been to visit him because I want to see the environment he is in (not great but better than with his mother) and to see how he functioned in it. When he is back over break, I plan to have him put in an application to a college here, just in case he does badly again this semester or things go south and he needs more support...but then we would need to find him a place to live because our apartment is too small until my daughter goes to college in a year and a half...

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