I was diagnosed in my 40s with Bipolar with with psychosis. Eventually I started having delusions that appeared outside of any mood episode. For awhile my pdoc and I thought maybe i am schizoaffective. But after sometime my pdoc settled back to the view that I am bipolar 1 since my predominant symptoms by far are mood disturbances rather than thought disturbances.

In any case I take a small dose of Rexulti (which is for schizophrenia not bipolar) at night and that seems to keep all the psychotic symptoms at bay. I have tried mood stabilizers to lift the depression but they didn't help or I couldn't tolerate the meds. For instance lithium greatly exaggerates my hand tremor to the point i was not able to eat soup with a spoon even on a small dose of 450mg a day. Neither lamictal nor lithium at the dose I was able to take prevented manic episodes. Standard antidepressants either make me manic or do not help. So my depression is intractable.

I keep very close track of my sleep and if I start to not sleep at least 7 hours a night i take a small dose of 1.25 mg olanzapine prn. Since it is only every now and then it functions like a great sleep medicine for me. If I don't maintain my sleep I can slip into a psychotic mania.

I have been stable the last 2+ years.