I rapid cycle, too, and often get mixed episodes. Mine are (thankfully) short-lived and not that severe because I have Bipolar 2 (and OCD) and I'm mostly stable on meds (I still struggle with my moods and worries, though). I keep very close tabs with my p-doc and I insist on going in to be seen sooner as needed. I'm very sensitive to any changes in my mood and I try to stay on top of seeing my p-doc if I think I need an adjustment.

Does your p-doc know about all these symptoms? Does your p-doc know about the self-harm? It sounds like you might need a medication adjustment.

I take Latuda, also. I take a higher dose, and I found that Latuda has helped the most with my anxiety out of any other bipolar medication I take. I hope you get some relief soon!

Lithium XR 900 mg
Trileptal 1500 mg
Latuda 120 mg
Risperdal 1 mg
Xanax XR 0.5 (2x a day)
Xanax 0.5 PRN for anxiety attacks