Spent almost an hour on the phone with the inpatient psychiatrist Dr. C. She is great and I am so relieved we got her. She's keeping him for at least a couple days, maybe a week. Dr. C said he was "all over the place" there and they had to give him both Klonopin and Trazadone to get him to sleep last night. Definitely a manic episode. She lectured me on getting him into the hospital immediately the next time this happens. She said there are now some good docs at one of the other psychiatric hospital with an adolescent unit and I should take him there next time if their psychiatric hospital is full. She is checking his thyroid levels - said she was wondering if he might have developed autoimmune thyroid disease since he has another autoimmune disease and there's a strong family hx. Biggest thing --- I thought to mention the choking incident to her. She was very unhappy that the school didn't call 911 and she wasn't too happy with the minimal assessment they did in ER either. She said that after being strangled there can be sudden and severe swelling that is delayed and could be life-threatening. I am glad to know my first instinct - why the heck have they not called 911??? - was the right one. But she also said that it might have led to the manic episode and she was going to run thyroid labs today for sure. Dr. C said that neck trauma (like being choked) can cause pressure on the thyroid which causes a sudden release of thyroid hormones to flood the body. She said this is rare but it can cause mania/psychosis in even normal people. She called it a hyperthyroid crisis. So I have dropped a little line to the principal, ED teacher, Special Education district program specialist and our advocate passing on this concern. If the principal doesn't get called on the carpet for not calling 911 I would be surprised. I am so relieved that they are keeping him I cannot say. I'll keep you updated.