My fiancé is experiencing a month long psychotic episode. Help!

Honestly, I think a month is too long to call it an 'episode,' there's clearly something else going on there; after reading your post, I'd be thinking about schizophrenia too. The lithium should help with mania (it is the front line stand-by), but those just might not be the right antipsychotics for him, especially when he doesn't seem to be responding to the ones he's currently on. Do you know if they have tried different antipsychotics? I'm guessing they're working with atypicals, but I know some people who have only responded well to the old-school antipsychotics (I knew a girl who saw giant glass spiders shooting laser beams, nothing touched her hallucinations until they tried thorazine).

You know, the more I think about it, the more it sounds like schizophrenia--and I should know, as that happens to be my disorder. Bipolar can often show psychotic symptoms, true, but it's not uncommon for bipolar to be misdiagnosed as schizophrenia, and the other way around, too.

As for the marijuana, there's no real evidence that it causes psychiatric disorders, but there is some that indicates it can exacerbate what's already there. So yeah, that could have been a trigger, but only if he had a predisposition to to whatever his disorder actually is.

There is hope--proper meds and therapy can make a HUGE difference. And sadly, yes, some people do snap and never come back. I think a month is way to early to be thinking along those lines, though.

Hope things get better for you. Post back if you want to talk.