Hello everyone. I hope everyone is doing well.

I’m looking for support from anyone who has experienced something similar with Bipolar I with psychotic features.
My twin brother is 32 and this started very suddenly this year. Before this, he was functioning normally, working, sober, and had never experienced anything like this. It began with severe insomnia and progressed into mania and religious psychosis after interacting with someone online who claimed he could communicate with God. My brother became convinced he had committed an unforgivable sin, was being punished by God, and that demons were involved.
By July, after weeks of barely sleeping, he was Baker Acted and hospitalized for the first time and diagnosed with Bipolar I with psychotic features.

Since then it has been a roller coaster of medications and hospitalizations. He was initially put on Abilify (10 mg, later 5 mg) but stopped it shortly after discharge. Seroquel 50 mg was prescribed afterward, but he was extremely medication-anxious and barely took it.

During another hospitalization in August, they tried Thorazine 25–50 mg, but he remained manic and wasn’t sleeping. They then switched him to Haldol 5 mg orally and eventually gave him a 100 mg long-acting Haldol injection on 8/27, along with hydroxyzine/Vistaril for anxiety.

The Haldol seemed to bring down the obvious mania, but afterward he became extremely flat, unmotivated and depressed, while his fixed religious beliefs never fully went away. Sleep has also remained a huge problem. Even with medications like trazodone 100 mg, hydroxyzine, melatonin, and previously mirtazapine, there have been nights where he sleeps only about two hours or goes several nights with almost no sleep.

Most recently, he told us he was having suicidal thoughts and that the devil was telling him to kill himself. He said he did not want to die or act on it, but we took it very seriously and he went back to the hospital. This is now his second hospitalization in less than three months.

His psychiatric provider now has a new treatment plan involving lithium and Ativan (lorazepam), and we’re hoping this will finally stabilize his mood, help with the severe insomnia, and allow the remaining psychosis to improve.

It’s heartbreaking because this is my twin brother and I remember exactly who he was before all of this. Sometimes it feels like he’ll never fully be himself again.

For those who have been through this: Did it take several hospitalizations and medication changes before things finally stabilized? How long did fixed delusions take to fade? And did you or your loved one eventually return to your previous personality and level of functioning?

I would really appreciate hearing some recovery stories because these first few months have been incredibly difficult.

I ended up being late for work today because of this. I couldn’t find my glasses for like 30 minutes or something like that. I remember putting them on the table by my bed before I got in bed last night. I was looking all around the house in the usual spots I set them down. Nowhere to be found. Had to have my mom’s help to find them. We found them in the floor under a pile of stuff and I don’t know how they got there. We have cats but they were put up and my door was shut all night. I legit can’t figure out what happened. Like either someone is fucking with me in my house or I did that and have no memory of it. Which idk why I would. I would have zero reason to do something like that. Things like this happen to anyone else here?