My 26 year old brother has bipolar disorder type I and ADD. Our parents and grandparents are all deceased and I've been supporting him off and on since 2012 when he graduated high school. He has a history of substance abuse, had a major suicide attempt (I paid for him to live in a group home for nearly a year after) and has been in and out of inpatient psych treatment facilities since he was in high school.

He is currently taking escitalopram, quetiapine, clonazepam, and Concerta extended release.
He has issues with mania and insomnia and I'm really thinking Concerta is doing more harm than good. He had a history of abusing Ritalin before he got the extended release. 

I put the 30 day Concerta supply in bubble/blister cards and write the day on top of each bubble to keep track. I just discovered that he has taken 5 tabs from the opposite side of the bubble pack. He didn't punch/push them out, but carefully sliced the backing. He was really upset earlier this evening and had mentioned going to the hospital. I think he was having effects from taking the extra tablets and also feeling guilt from doing it (I didn't know at the time).

Does anyone else with bipolar disorder and ADHD have any insight on medications? Should I advise him that he needs to go to inpatient &amp; talk to the psychiatrist about med changes (I've taken him many times)? I really think he should be off stimulants. 

Thanks.