I have a child (under 10 years old) clinically diagnosed with Bipolar Disorder with Psychotic Features. Her father has schizoaffective disorder and schizophrenia spectrum disorders have a very long and extensive history on his side going back generations. Her therapist and psychiatrist are watching her closely but the general consensus is that it's highly likely her diagnosis will change in a few years, probably to schizoaffective like her father. To make it easier on receiving help, her psychiatrist has given her the bipolar diagnosis for now (insurance refused to cover medication without diagnosis).

She lives in an almost constant state of manic-type behavior (extreme hyperactivity and it's not ADHD. ADHD medications make her positive symptoms and aggression 10000x worse) which we've got mostly stabilized with lithium. Her problem area, however, is her psychotic symptoms. She has positive symptoms (particularly her commanding hallucination Dark Man) and paranoia/delusions, the severity of which fluctuates. Her negative symptoms are a bit more subtle but there. Even with the therapeutic level of lithium and the subsequent stabilization, the psychotic symptoms continue. And they're constant. They've impacted her life at home and school. She has no friends (nor does she want them), isolates herself most of the time, and is having cognitive difficulties in school, likely related to disorganized thought and lack of memory recall as evidenced through her schoolwork and neuropsychological testing (testing done when we originally thought this was ADHD). She's been hospitalized multiple times for behaviors including suicidal and homicidal ones.

We've tried Abilify, Geodon, Risperdal, and currently on Seroquel. We're hesitant to try any more of the atypicals because they just seem to not work. She's on 500mg a day of Seroquel with no sedative effect (which was a reason that one was eventually chosen because she has issues with sleep). Her psychiatrist said we could try Zyprexa but after going through these medications, I'm just not as confident as her.

Any insight or help would be appreciated. We know all we're doing is managing her symptoms so she can have some functionality but we're losing her more and more every day. And as much as I'd rather she not be on them (because I really would like the atypicals to work), I'm wondering if we should begin to consider something like Thorazine.