if it was an episode of mania from being hardcore bipolar dos, he'd have been losing his mind since his late-teens with some degree of regularity if he's not one to take his meds when he's ramping up.

what happens chemically in the brain of someone in cocaine-amphetamine psychosis is so close to what causes a psychotic episode or weeks of mania. the fact tons of blow happens to be involved, his age, and the lack of psych-ward episodes in the last 20 years doesn't sound like there's any persistent condition that serious.

it's textbook stimulant-related psychosis. take the cocaine away and kick it out of where it's binding to and the run's over if you can stop him from just going and doing more blow.

frankly, you're not going to put him on a mood-stabilizer and something like risperdal unless you want to fatten him up like a goose for pate for no reason. fucking stick him with haldol for a few days if you want to pull the battery out of the guy-he doesn't need things that don't act immediately. seroquel's going to have major advantages over prior gen stuff like risperdal in working in 20 minutes and having the option of a theraputic range so freakishly wide of anything similar(12.5-800mg) that it's going to be flexible AND it's also got major sedative properties compared to well, most shit short of chloryl hydrate and haldol through an iv with fingers crossed he wakes up.

a year from now without any stimulant runs for weeks at a time and no history of going off the reservation without cranking up his dopamine levels like someone whose brain does what a quarter ounce of blow a day does to him were born that way are going to present the same way.

the problem is distinguishing and underlying disorder you'd treat with shit like lithium and risperdal would be the wrong thing when it'll take months before you can diagnose someone who just went on a monthlong coke binge. brain's not going to be close to whatever it's equilibrium is, stimulant removed, to try to diagnose anything that closely resembles the symptoms of what you can do to yourself with the drugs he was doing.

if you were working with people not on a coke/speed binge for weeks and clearly bipolar with sober episodes of mania, you guys are all absolutely right-the thing is you can reproduce the behavior and chemistry out of the blue with heavy stimulant use and an atypical antipsychotic that works fast to act as some kind of full or partial agonist, you can look it up, but you want to shoot the engine block out of the guy with a barrett rather than let him hang around then go suicide bomber before the meds work.