Diagnosis isn't all that important. The label helps guide treatment and is useful for insurance. Doctors diagnosis Bipolar I much differently than they did back in the day, when manic depression was thought to be a rare condition with a fairly good prognosis. Back then, a lot of people who have "Bipolar" these days would have been diagnosed with some kind of Schizophrenia, maybe a sub-type of depression, etc.

Do the drugs work? Are you concerned about adverse effects, long term effects, etc.?

When there's psychosis, some old school doctors go for Schizophrenia/Schizoaffective (especially when the person is a minority and/or poor), while some more modern doctors go for "Bipolar I w/psychotic features," especially when the patient is white and comes from a more affluent background.

I wouldn't worry too much about the label(s).