Hi @MrAbbott. Welcome! I'm glad you joined us. I have bipolar type 1, as well, and during my more severe manic (and mixed manic) episodes I also became psychotic.

I can't know your psychiatrist reasoning, but wonder if s/he doesn't raise your med doses (in precaution) to avoid extra/new side effects. I think "as needed" prescribing is generally better than over-medicating. I assume s/he would raise your medications if/when you become manic? If not, is s/he depending too much on you first being hospitalized? If the latter, I totally agree with you that is too late. Nipping elevation by the bud is better, but see that strategy as best only when there is at least some level of elevation. Not if you are stable, but it's simply the time of year you used to become manic.

Insight into developing mania is possible but I think requires a bit of experience. You, yourself, could do a self check, but also family and good friends could clue you in. Ask them to do so. If you're particularly joyous or agitated/irritable, of course you may have valid justification. Or don't you? If I see my mood/energy is rising, I may "lay low" a bit and avoid known triggers. Early spring is my vulnerable time, as days lengthen with more light. Is my sleep affected? Am I socializing a lot more than usual? How about my physical activity? Perhaps I cut down on overly stimulating things for a bit.

I have been allowed (and even encouraged) to take a prn ("as needed") medication when mood elevation is suspected. My old psychiatrist would make a recommendation on how much and for how long I could use it before needing to call him. I (and my husband) have seen this as an extremely valuable tool that has spared me hospitalizations in the past. It's a shame your doctor won't consider this. Have you discussed "prns" with her/him?

Great topic! I hope you get more suggestions.