Clinical features of delirious mania: a series of five cases and a brief literature review

BMC Psychiatry

Nan-Ying Chiu²  Wen-Yu Hsu¹  Si-Sheng Huang³  Bo-Shyan Lee¹ 

[1] Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan;Chang Jung Christian University, Tainan, Taiwan;Center of General Education, Central Taiwan University of Science and Technology, Taichung, Taiwan

关键词: Catatonia;    Mania;    Electroconvulsive therapy;    Delirium;    Bipolar disorder;   

Others  :  1124366
DOI  :  10.1186/1471-244X-12-65

 received in 2011-06-17, accepted in 2012-05-11,  发布年份 2012

【 摘 要 】

Background

Little is known about the cause and psychopathology of delirious mania, a type of disorder where delirium and mania occur at the same time. This condition still has no formal diagnostic classification. To provide more information about this potentially life-threatening condition, we studied five patients with delirious mania.

Methods

We describe the cases of five patients with delirious mania admitted to an acute inpatient psychiatric unit between January 2005 and January 2007, and discuss the cases in the context of a selective review of the clinical literature describing the clinical features and treatment of delirious mania.

Results

Two patients had two episodes of delirious mania. Delirium usually resolved faster than mania though not always the case. Delirious mania remitted within seven sessions of the electroconvulsive therapy (ECT).

Conclusions

Delirious mania is a potentially life-threatening but under-recognized neuropsychiatric syndrome. Delirious mania that is ineffectively treated may induce a new-onset manic episode or worsen an ongoing manic episode, and the patient will need prolonged hospitalization. Delirious mania also has a close relationship with catatonia. Early recognition and aggressive treatment, especially with electroconvulsive therapy, can significantly reduce morbidity and mortality.

【 授权许可】

   
2012 Lee et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Karmacharya R, England ML, Ongür D: Delirious mania: clinical features and treatment response. J Affect Disord 2008, 109:312-316.
• [2]Weintraub D, Lippmann S: Delirious mania in the elderly. Int J Geriatr Psychiatry 2001, 16:374-377.
• [3]Kraepelin E: Manic-Depressive Insanity and Paranoia. In Translated by Barklay RM. Edited by Robertson GM. Edinburgh: Livingstone; 1921.
• [4]Klerman GL: The spectrum of mania. Compr Psychiatry 1981, 22:11-20.
• [5]Carlson GA, Goodwin FK: The stages of mania. A longitudinal analysis of the manic episode. Arch Gen Psychiatry 1973, 28:221-228.
• [6]Taylor MA, Abrams R: The phenomenology of mania. A new look at some old patients. Arch Gen Psychiatry 1973, 29:520-522.
• [7]Mann SC, Caroff SN, Bleier HR, Welz WK, Kling MA, Hayashida M: Lethal catatonia. Am J Psychiatry 1986, 143:1374-1381.
• [8]Fink M: Delirious mania. Bipolar Disord 1999, 1:54-60.
• [9]Fink M: ECT has much to offer our patients: it should not be ignored. World J Biol Psychiatry 2001, 2:1-8.
• [10]Taylor MA, Fink M: Catatonia in psychiatric classification: a home of its own. Am J Psychiatry 2003, 160:1233-1241.
• [11]Detweiler MB, Mehra A, Rowell T, Kim KY, Bader G: Delirious mania and malignant catatonia: a report of 3 cases and review. Psychiatr Q 2009, 80:23-40.
• [12]Fink M, Taylor MA: Catatonia: subtype or syndrome in DSM? Am J Psychiatry 2006, 163:1875-1876.
• [13]Bond TC: Recognition of acute delirious mania. Arch Gen Psychiatry 1980, 37:553-554.
• [14]Hirose S, Horie T: Effectiveness of ECT against delirium during an episode of bipolar disorder: a case report. JECT 2000, 16:316-317.
• [15]Swartz MS, Henschen GM, Cavenar JO Jr, Hammett EB: A case of intermittent delirious mania. Am J Psychiatry 1982, 139:1357-1358.
• [16]Strömgren LS: ECT in acute delirium and related clinical states. Convuls Ther 1997, 13:10-17.
• [17]Friedman RS, Mufson MJ, Eisenberg TD, Patel MR: Medically and psychiatrically ill: the challenge of delirious mania. Harv Rev Psychiatry 2003, 11:91-98. 18
• [18]Hill KP, Oberstar JV, Dunn E: Zolpidem-induced delirium with mania in an elderly woman. Psychosomatics 2004, 45:88-89.
• [19]Bobo WV, Murphy MJ, Heckers SH: Recurring episodes of Bell’s mania after cerebrovascular accident. Psychosomatics 2009, 50:285-288.
• [20]Ritchie J, Steiner W, Abrahamowicz M: Incidence of and risk factors for delirium among psychiatric inpatients. Psychiatr Serv 1996, 47:727-730.
• [21]Kramp P, Bolwig TG: Electroconvulsive therapy in acute delirious states. Compr Psychiatry 1981, 22:368-371.
• [22]Loo C, Katlinic N, Mitchell PB, Greenberg B: Physical treatments for bipolar disorder: a review of electroconvulsive therapy, stereotactic surgery and other brain stimulation techniques. J Affect Disord 2011, 132:1-13. Epub 2010 Sep 21
• [23]Danivas V, Behere RV, Varambally S, Rao NP, Venkatasubramanian G, Gangadhar BN: Electroconvulsive therapy in the treatment of delirious mania: a report of 2 patients. JECT 2010, 26:278-279.
• [24]Levin T, Petrides G, Weiner J, Saravay S, Multz AS, Bailine S: Intractable delirium associated with ziconotide successfully treated with electroconvulsive therapy. Psychosomatics 2002, 43:63-66.
• [25]Alici-Evcimen Y, Breitbart W: An update on the use of psychotics in the treatment of delirium. Palliat Support Care 2008, 6:177-182.
• [26]Nicolato R, Costa-Val A, Souza A, Teixeira AL: Delirious mania associated with bipolar disease in a Brazilian patient: response to ECT and olanzapine. J Neuropsychiatry Clin Neurosci 2009, 21:477.
• [27]Fricchione G, Bush G, Fozdar M, Francis A, Fink M: Recognition and treatment of the catatonic syndrome. J Intensive Care Med 1997, 12:135-147.
• [28]Van Den Eede F, Sabbe B: Catatonia in psychiatric classification. Am J Psychiatry 2004, 161:2327-2328.
• [29]Philbrick KL, Rummans TA: Malignant catatonia. J Neuropsychiatry Clin Neurosci 1994, 6:1-13.