Asperger/bipolar teen is hearing voices urging aggression

[WendyLB4]

Our 17-year-old son was diagnosed with PDD at age 3.  Bipolar disorder was suspected at age 5 because of seasonal mood swings, intermittant explosive aggression and substantial family history of the disorder.This diagnosis was changed to Asperger Syndrome/HFA and bipolar disorder with psychotic features at age 10, when he was hospitalized briefly due a psychotic belief that he was a dinosaur on a mission to kill all humans.  (Dinosaurs have been his area of narrow focus since early childhood.)  He typically feels and expresses great remorse after a rage and notices when those around him seem upset.  After many changes of medication, therapies and special school programming, his impulsive aggression had become rare and he has been able to consider consequences and calm himself in most cases.

However, in the past two weeks, he has begun to hear what he calls "a deep, scary voice in my head" that tells him to do things or accuses him of things.  After a rage (when he had calmed himself with great difficulty) he admitted to me that the voice had been telling him to kill me, and this scared him.  (Me, too.  After a recent growth spurt our son is suddenly 5 inches taller and 40 pounds heavier than me!)  Today, he suddenly became angry at school, punched one teacher and try to bite another (behavior we had not seen in years.)  He admitted to me later that the "deep, scary voice kept calling me a coward for not fighting and I didn't know what to do."  He lives in fantasy a lot based on the dinosaur documentaries and Disney-type animated films he loves, but it is unlikely he picked this idea up from one of those sources.   He is remorseful after each episode, but very discouraged--and has seemed to have a decline in both cognitive and motor skills.  Is some kind of degeneration occurring in our son's mind?  Is he heading into another psychotic episode?  

[ames67]

Does your son see a developmental pediatrician along with his psychiatrist? Since he has the diagnosis of bipolar with psychotic features it sounds like this is another episode. The psychotic features are usually present during a manic episode as well as the rages. Being 17 puts him in a rough place, there are lots of things going on developmentally and with the brain that can influence him having an episode, not to mention the stress of being a teenager in general. That may be why you are seeing this behavior now. Sounds like he needs a medication adjustment. In terms of the cognitive and motor skill decline I would make sure the psychiatrist knows this. I am wondering if it could be a side effect of some of his medications. Please take care of yourselves.

[DLA]

Sometimes mentally ill children go through puberty later than the other children, and since you said he just went through a major growth spurt I'm wondering if this could have anything to do with it.  I remember well when I was a teenager and the boys all hit puberty.  Apparently the influx of testosterone made them really agressive b/c they fought over EVERYTHING.  Of course, I'm not a dr just a person on the outside looking in.  ;-)

Hope you and him find answers soon.  Am praying for you both.  And am really praying that the scary voice leaves him soon.  How terrifying that must be for him.