### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My stepfather is 72 yrs old. Has been diagnosed w/ paranoid skits manic depressed @ GRN close to 23 yrs ago. Has had follow up @ Avita in Blairsville, Ga. by Dr. Dixon. Has been medicated with risperdal & bupropion all these yrs. My mother died in May 2013 & he decides he don t want to take his meds anymore. His Dr., Dr. Allen Sanders agreed to try him off of his meds as did I agree. I seem to think we should have never tried it. I m having a lot of problems with him ever since. He s so child like it s like I have a 10 yr old boy to deal with & it makes things so hard for me to help raise my 17 niece as she has been raised by my mother & stepfather until my mother died & now He & I share custody. mom had legal guardianship of him & my niece & I was going to see could he manage being responsible for his self & his welfare. I ve lived w/ them now for 8 yrs taking care of all 3 my mother, my step father & my niece. I need to find a highly educated Dr. in this field that can determine what step I should take next for his better health. I do feel things need to go back the way they were before my mother passed away because I m not sure how much worse things may get.

### output:

Hello and welcome to Chat Doctor. Thanks for your query. I understand that you must be going through a very difficult time, taking care of your step-father as well as other family members. From the limited information that you have provided about your step-fathers mental illness, it is difficult to come to a conclusion regarding his diagnosis. A detailed history and a proper psychological assessment is required in order to arrive at a definitive diagnosis. However, I would like to let you know that Paranoid Schizophrenia and Manic Depression (or Bipolar Disorder) are two entirely different psychiatric illnesses and a person cannot have both diagnoses at the same time. So, I would suggest that you clarify with his psychiatrist about his diagnosis and discuss what would be the best line of management. Most of the time, medication is essential and stopping medication may cause worsening of problems. If he is not willing to take tablets, then there is the option of giving long acting injections, once or twice a month, which can be equally effective. Please discuss this with his psychiatrist. Wish you all the best.