difficult child 2 had a full blown manic episode starting Wednesday evening. He didn't sleep for more than 36 hours. When he finally did sleep yesterday afternoon it was for 3 1/2 hours. I tried to find him a bed yesterday morning after he had been up all night. I stayed up til 2:30 am waiting to see if he was going to sleep. He would suddenly pop into the family room where I was hanging out, laugh and giggle, stomp around some maybe exchange 2 or 3 words with me and then he'd disappear again. Around 12:30 am he came out waving a sheaf of papers and told me he was writing a story but his hand hurt. I finally went to bed at 2:30 because his light was off and he hadn't come out to see me for about 45 minutes. I didn't stop and open his door to see if he was actually asleep. Apparently he was looking at the stars - not sleeping. He surprised wife when he came in the house from the front yard around 5:30 am while she was getting ready for work. He told her he had been up all night and had been outside for a while waiting to watch the sun come up. He alternated between raging and crying and laughing for a couple hours while I tried to reach the doctor on call and finally gave up and called the psychiatric hospital myself. Turns out our psychiatrist's office only has on call docs available from 5 to 10 pm. After that we are supposed to take patients to ER or wait until 8 am when the offices open. Wish someone had told me that - I wouldn't have wasted 3 hours trying to get someone to call me back. When I couldn't find an adolescent bed I decided to try to manage him at home rather than spend countless hours in our ER which is the main trauma center for the region. Luckily he got "happy" and I got some food into him and then set him up with his favorite one player video game. He started playing it and narrating it at the top of his lungs. Then he stopped, hooked up his audiobook to the stereo and went back to playing the game, listening the book set on LOUD and narrating his game play again. He stayed that way for the next 2 hours - thank goodness. He had refused his medications the previous evening but I was able to get him to take them around noon. psychiatrist called at 2 pm to ask me if anyone had called me back. NO I said, no one has called me. We discussed things and the psychiatrist told me to give him his regular medications around 9 pm along with an increased dose of Geodon. He was really surprised that difficult child 2 didn't go to sleep after he took his regular medications at mid-day. We agreed that if he didn't sleep, got combative again, or resumed unsafe behavior (the night before he went in the garage full of woodworking equip and tried to pull stuff down out of the rafters) then I would get him to ER. He finally fell asleep around 4:30 pm. Then got up again about 8 pm. We were able to get the evening medications into him around 9 pm. He said he was really tired but his brain was still racing. He stayed up until 10 pm and then went back to bed and has been asleep ever since. I've tried to wake him up this morning but no luck so far. I'm really worried - he's getting more and more unstable despite medication changes and dose increases.