Q. I have been diagnosed as only unipolar depressive, but there is a family history of Bipolar illness as well as schizophrenia. I have recurrent psychosis even while on medication (Perphenazine, Effexor XR, Xanax). My concern now is that I have psychotic symptoms appearing while my mood is not low, but merely incredibly irritable. Could I be some sort of masked bipolar? I am impulsive but I never have racing thoughts, pressured speech, lack of sleep, or grandiosity. Any suggestions would be appreciated. Despite all the symptoms, I am able to work and to care for myself and my pets.

  A. It could be an agitated/irritable bipolar illness or it could be borderline personality masquerading as bipolar II disorder. I would review your concerns with your doctor, and see about getting on an anticonvulsant. I like topiramate because of the lack of weight gain, but they all should or could help (Tegretol, Neurontin, Lamictal, Depakote). If what you are doing is not adequate, and it is not since you still have some symptoms, review with your doctor available treatment options, and try one of those suggested by him.