Treatment-Resistant Juvenile Bipolar Disorder with Psychosis

13-year-old white male was admitted to the child and adolescent psychiatry unit at our institution. He was referred to us by his outpatient therapist. He had become increasingly aggressive (both verbally and physically), agitated, unable to sit still, and was pacing and talking incessantly. His speech was pressured, rapid, and mumbled. He was acting out sexually by masturbation. He also had auditory hallucinations (was hearing a “good voice”) but no visual hallucinations. He had paranoid ideations that someone was breaking into his home, and he was talking to himself and responding to internal stimuli. His sleep and concentration were reduced but his appetite was adequate. Suicidal and homicidal ideations were absent. His symptoms had been getting worse in the weeks prior to