I don't even know where to begin. I found this forum a couple of months ago and just reading the posts has helped me a lot. But now I am at a loss for what to do. Short version of the situation: difficult child - D-man is 16 and has lived currently with me and his aunt since August when he ran away from his grandparents house (aunt's parents). We agreed to take him in and thought we were making progress. He has a real problem with me and thinks that I took his aunt from him, etc. When he is on his medications we can get along, especially if it suits him, i.e when he wants something. I keep telling myself it is not about me when he makes personal attacks and his therapist is good and dealing with the issue. Problem is the blankity blank NURSE PRACTICIONER that he sees for his medications. About a month and a half ago, when he went for an appointment and she asked he how he was (that is how she evaluates him, nice huh?) he actually commented that he had been feeling very angry, irritable lately. I have had issues with this women for a while because she makes his diagnosis seems like a national security issue - finally she told his aunt he had been diagnosis Bi-polar, but told his g-mother they were waiting until he was 18 to give him a diagnosis ( I think this is for the Borderline Personality Disorder (BPD)?) Anyway her choice of medications has always been strange based on what I have read in numberous texts about Bi-polar treatment. He was on Risperdal 1.5 mgs, Effexor XR 75, Concerta 54mgs, and Visteril to help him sleep. Well he had started to develop breasts and we were concerned about the side effects for the risperdal, but here the kid actually says he is feeling angry all the time, and having trouble concentrating on homework, instead of his usual fine and what does she do - she ups the Effexor to 175, changes to Vyvanse, removes the rispersal and visteril and puts him on Geodon. He current is at 80 mgs and from the stuff I have read Geodon works to stop manic attacks but not to prevent future attacks. Needless to say the last two weeks have been getting progressively worse. Last Monday the aunt called the office to move up his appointment and get some more Geodon cause she only gave us samples instead of a script and SHE DID NOT RETURN OUR CALL. The next day G-mother called, same thing. Every day last week they called and no return call. I told SO that I was going to call myself and speak to the office manager because he actually ran out of Geodon on Thursday night. Luckily? Grand mother found some 60 mgs Geodon that he had been on in the last group home and we gave him those. His aunt actually went to the office on Friday and talked to the receptionist. Both were upset and she forgot to ask for more samples, but we did get his appointment moved to Monday. He is gone this weekend with his grandfather (they go hunting almost every weekend - smart- give the kid a gun, right?) and will be back on Sunday. Here is the thing. He is basically off his medications right now - I see the difference in him right away. He flipped out on Thursday night demanding a cigarette. Very calmly we asked him to put down the butt he picked up and his aunt continued telling him she would not give him a cigarette. Finally he threw it on the floor insulted us and went and took a shower, telling us to stop wispering from the bathroom and that he would smoke a cigarette before the night was through. He also got his report card that day and refused to give it to her. We already know that it is straight F's cause she had been in touch with the school and we were planning to let him go the the community college in January. The rule is he goes to school or gets a job. He really does not want to work. He is fairly managable when he is on the proper medications. Why have they not put him on a mood stablizer with the a-typicals?????????. Here is the kicker. He has never been physically violent with us although he is emotionally abusive. On Friday morning he made it clear he thought everything was my fault by ignoring me, slamming the door, etc. He was laughing in the car on the way to school according to his aunt. On Friday his granddad picked him up from school and brought him here, why I dont know. He was here along for a little while until his aunt got home. She then took him back to the Granddad's house so they could leave for the hunting trip. D-man called later that night and asked his aunt if she noticed anything different or interesting and where we had been in the house. She told him I was cooking and she was working and left it at that. We searched the house after the call but could not find anything. I had to have part of my toenail cut off on Tuesday (something he himself had done in September, the last big meltdown) and he knew and saw me cleaning it with the Bactine and other supplies. Finally around 10pm. he called back, three times in fact cause she was not going to answer the phone. He went through his normal where are you, want are you doing routine and then said he thought he would play a joke and was'nt it funny and had we figured it out yet. She told him no and he said he had dumped out the bactine and replaced it with alcohol.. I checked and he really did. He kept asking her if she thought it was funny, she said no that it would have hurt. I encouraged her to get off the phone which she did. Needless to say I was shaking. He was here in my house plotting how to delibertly hurt me. I am afraid that he will end up hurting the animals or one of us. I was not even the one who told him he could not have a cigarette! What can or should we do? He is not stable and we talked about trying to get him admitted some where inpatient. I really think that this situation is not going to work for him because he has said it is not want he wants - he wants a mother and a father or his aunt without me. His mother cannot keep him, in fact she has told him throughout his life she does not want him because he is hard to handle - also she is bipolor and has a personality disorder herself. Actually his therapist made D-man and his aunt agree that he was not to even go back to visit with his mom, because last weekend he argued to stay there and ended up smoking pot - though he swears not with her this time. The therapist said if they could not agree not to let him go there then she would have to call social services. I would really appreciate any advice. We live in the Charlotte NC area and he is on Medicaid. I think he would benefit from a highly structured residential treatment program, but I don't know if they will take him because he will say he is not suicidal or does not want to hurt anyone (except me). Please help. I don't want to give up on him and I made a promise to myself that I would not tell him to leave, but I don't think we are able to help him. Even on his medications he is not making much progress.