Is this Grandiose?

[ObiQuiet]

Hi there, my son is 14, and we've travelled a very long road.  Grade 1 was diagnosed with ADHD & ODD,meds - Concerta then switched to Strattera.  Grade 4 was diagnosed with Bipolar Disorder after an apparent psychosis.  Later the diagnosis was switched to Major Affective Disorder.  Referred to another psychiatrist who advocated a "wait & see" approach.  He has maintained a low dose of 2nd gen antipsychotics (.5mg risperdal & 125mg seroquel) since age 9.  Has had 2nd suspected psychosis in grade 7. We saw grandiose statement "he runs this school", agitation and explosivity in both episodes,  2nd episode seemed paranoid, possible visual hallucinations.

He is now finishing 1st year of high school, and it has been a stellar year.  We planned to try coming off meds (maybe this was just complicated ADHD with explosivity after all - we know anxiety is on board, and suspect very high functioning aspergers, but neither has been officially recognized).  He hasn't had any issues at school THIS YEAR ONLY to speak of, is keeping a great group of friends, busy with school activities, great grades, and doing well with our relationships at home!

However, got concerned yesterday while talking to him about bear safety in the trails near our home.  He insisted for over 15 minutes that he could EASILY take on a bear.  He would punch it in the jaw, or hit with a stick.  He KNEW he could take it on and win.  I asked if he thought his other friends were capable of this.  He said if they worked as a team they could too (ie: if he was with them).  I said I needed to know he was in touch with reality, and that if he came across a bear that he would do the safety things: make loud noise, make yourself big, back away slowly.  He assured me in the end that he knew that, but that if he HAD to face an attack, he knew he would win.  He is not a super tough, super in shape kid - plays lots of video games.  Is this grandiose, or just 14 yr old male machismo?  Does this mean mania is pending?

[ObiQuiet]

Thank you Dr. Forster,  he seemed pretty calm last night, and had a good sleep.  I'll be spending quite a bit of time with him today as well.  I'm pretty certain he's not in a manic phase, or even hypo-manic, but I guess I was wondering if these type of things pop up if he's cycling up, sort of a gradual up swing?  And if so, is there anything that can be done to help head it off if we're early enough?

[Peter Forster]

It isn't possible to make a diagnosis by email, but I can understand your concern. Mania is not just one symptom, it is a syndrome, and you might want to consider whether your son has other possible manifestations such as -

    A period of enhanced self esteem, a stronger sense of personal value or importance, perhaps even the experience of being somehow central to some other purposes, a sense of being connected and related to others.
    A feeling of being tireless, indefatigable, unwearying, of being able to mount a sustained effort and of having unflagging energy. Often associated with doing well with less sleep than usual.
    A time of being animated, lively, talkative, friendly and willing to talk to those that one might not ordinarily be comfortable speaking to.
    A period when one's thoughts are inventive, fanciful, original, imaginative, individualistic, unique, unusual, uncommon, distinct, different, and perhaps even moving at a rapid tempo or flying.
    A sense of being drawn to things that are often missed. Fascinated by things around one, seeing things in a new way, the colors may seem brighter, smells and tastes richer, an experience of pleasure in the senses.
    A time of being productive, energetic, prolific, successful, profitable, restless, perhaps fretful, possibly ceaselessly in motion.
    Having the experience of being adventurous, wild, engaging in an escapade or affair, being unusually athletic, a daredevil, bold, an adventurer, or a risk taking entrepreneur, intensely enthusiastic, perhaps being a big spender and not worrying about the consequences.