Psychotic manic depression is not uncommon. What it requires is an anti psychotic like Abilify until the psychosis stops. Unlike schizophrenia or a psychotic disorder the psychosis appears within mood symptoms. If it doesn't and has lasted at least two weeks, then your daughter is schizoaffective and not bipolar. The difference being that schizoaffective is a combination of schizophrenia and bipolar. Of course, there are different forms. Some forms are more like schizophrenia with a mood component, some are bipolar with a strong psychotic component. I would recommend ruling out schizoaffective disorder in the case of your daughter. Psychiatrists once labeled me with bipolar disorder only to find later that I have some form of schizophrenia. I think that you won't have to worry about schizophrenia in your daughter's case however. Like I said, rule out schizoaffective illness. And if the Abilify doesn't work (believe me it doesn't work for A LOT of people, like me for instance) try some other anti psychotic. I'm on Geodon and feel much better than on Abilify or Risperdal. I wish you and your daughter all the best.