I am a retired Family NP. My 20y/o granddaughter was dx Bipolar in Nov 17 after being on streets and using multi drugs for about 6 months. She is on effexor,Depakote with zyprexa at HS and trazadone, and ativan PRN. She is somewhat stable but has been Manic today was texting her Mom @4am and making little sense,rapid speech during day- some visual hallucinations thought a boyfriend was sleeping here. She was functional but hyper. I had her take an ativan about 4Pm and she rested. I went to bed at 11PM and @ 11:30 she was up dressed, packed to leave and very anxious thought someone had stolen her 2y/o (who is at home with her grandma who is guardian of baby. She refused to go to hospital- B/P 130/80 Pulse 101@ 11:45.She was less anxious- I talked with her acknowledged how frightend she must have been for baby-she took her HS meds,Depakote,periactin,trazadone,prosozin and a PRN Ativan.She is innightclothes and much quieter,apologizing for being bi-polar. What symptoms would mandate that I call EMS against her wishes? This is the most agitated I have seen her in the 3 months she has lived with me. Thank you for your input.