Note: The first part of this answer addresses the original question, before it was edited. The newly added big red shoe is something quite different, and actually a separate question.
Yes, you either need the first comma or an additional conjunction:
- He is a deranged, fanatical and stupid person.
- He is a deranged and fanatical and stupid person.
Without the first comma or another conjunction, it violates the normal convention of conjunctions of three or more items.
It also looks like a typo involving a missing hyphen for only two adjectives:
？ He is a deranged-fanatical and stupid person.
→ He is a deranged-fanatical person and a stupid person.
However, the sentence as a whole is written in an order that makes it look very strange. This particular set of adjectives and noun is seldom used in this way.
Personally, I would remove the article and noun:
- He is deranged, fanatical, and stupid.
Or I would move person towards the start of the sentence:
- He is a person who is deranged, fanatical, and stupid.
Note that I added a serial comma at the end, but that's a matter of style. (However, I do think it helps illustrate the specific point being made here.)