My wife 55 years old and is suffering from bipolar disorder. She was initiall treated with lithium. She had depression 3 years later and was treated with fluoxetine and topiramide for about one year. Subsequently she has been treated with desvenlafaxine and lomotrigene. She is still taking lamotrigen 100 mg daily. Risperidone was tried twice but she had allergic rash and was discontinued. Present problem is severe irritability, she is disturbed by everything she hears - she feels as if others are speaking to her in a taunting manner and to humiliate her. Even if someone praises her husband she implies that the remark was to make her feel inferior. She is all the time tense and agitated, shouting for no reason and she does not get much sleep at night. She refuses to consult a psychiatrist now. Please advise.