Boy do I ever understand the irritability only for me it is a sign of worse things to come. If I can deal with this then I can usually head off the worse. Sometimes the worse seems not so bad though. What I mean is that I miss the highs that come with grandiosity and being spontaneous. Is this perhaps a reason you wish to avoid help you might receive at the hospital?

I am unsure why you wish to avoid this, except for perhaps you have previously had a terrible experience or have been turned off by the poor experience of others. In reality most don't have such bad times the wait in the ER generally being the worst. But this is your choice. I guess it comes down to how badly you think you need some help.

With this end in consideration though are there non-inpatient routes to take advantage of? Some communities have an in home program where they can send a counsellor to you. They can offer some therapeutic assistance and help you draw up a self-care plan. There may too be an EAP to take advantage of that can do the same via the phone. If you don't already perhaps find a support group to participate in. These are just a few things that come to mind.