Dr. Keith Roach, syndicated columnist

DEAR DR. ROACH: My daughter’s going through a manic psychotic break. Her reality is skewed, and she thinks that she’s right and that the rest of us are out of touch. It’s taking a toll on our family. How can I get through to her to seek professional help? — B.C.

ANSWER: Unfortunately, this is a common situation that often doesn’t have an easy answer. Mania is a specific psychiatric state when a person has a sustained period of very high energy. People in a manic state often don’t sleep much at all and have high energy, which they often use to make risky decisions that can cause long-lasting problems.

They can spend enormous amounts of money (often on things that they don’t need with money that they don’t have by using overextended credit), gamble, or have risky sexual behaviors. Some people become highly irritable and damage themselves, property or others with violent verbal or physical assaults. Acute mania is a defining characteristic of bipolar I disorder, which was once called manic-depressive disorder. As you can imagine, it can cause great distress for a person’s family and friends to see this.

During a psychotic break (the word “psychosis” here literally means what you said — a grossly skewed sense of reality), the person usually isn’t able to believe others. They often believe that they’re the only one who really understands what is happening. This can prevent them from accepting help.

During a very severe manic episode, a person needs to get into psychiatric care urgently. In this case, the disorder is so obvious that police are sometimes involved. However, a better option is a psychiatric crisis intervention team, if available. This reduces arrest rates as well as injuries to both patients and caregivers.

Without intervention, people like your daughter are at a great risk of causing themselves harm, so getting her to accept help before a crisis occurs is ideal but sometimes difficult. If she has a good relationship with her regular doctor or psychiatrist, enlisting their help may be useful.

DEAR DR. ROACH: I attract mosquitoes like nobody else I know! When I was younger, the bites would become large and hard. I’m 65, and if there are mosquitoes in my near vicinity and I don’t have DEET or picaridin on my skin, I will get bit and have multiple bites. Sometimes, the itchy bumps seem to last for several weeks!

What makes some people more reactive to mosquito bites than others? My husband’s rarely bothered. — T.D.

ANSWER: Blood type and other genetic characteristics may influence whether mosquitos bite you. Genetics also play a role in how severe the reaction will be. The reaction to the bite is largely related to your immune system. People with highly active (or even overactive) immune systems — such as people with asthma, allergic rhinitis or atopic dermatitis — are more likely to have severe mosquito-bite reactions.

Mosquito repellant with either of the products that you mentioned is your first-line protection, and rapid use of antihistamines such as cetirizine (Zyrtec) and steroid creams around the area of the bite will help prevent severe reactions.

EDITOR’S NOTE: Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.