![]() His family reported that his speech was pressured, and that he had begun wandering about without seeming to know where he was going. Our goal was to provide additional information about delirious mania and to illustrate the features of this condition and to highlight several challenges clinicians and researchers face in recognizing and treating this syndrome.Ī 53-year-old male began acting oddly about 1 month prior to being admitted to the hospital. In an attempt to better describe the course of delirious mania and to provide a clearer picture of this illness, we present a series of 5 patients diagnosed with delirious mania. Karmacharya et al did not find a large number of catatonic signs and symptoms in their study, while Detweiler et al supported Fink’s proposal. Taylor and Fink provided a classification of catatonia, and suggested that it be reclassified as an individual abnormal behavior akin to delirium and dementia, while delirious mania was posited in the same subtype as delirious catatonia (delirious mania, excited catatonia). Some authors have pointed to the high incidence of catatonic symptoms occurring in patients with delirious mania and also to the fact that both catatonia and delirious mania respond to electroconvulsive therapy (ECT). Other terms included lethal catatonia, malignant catatonia, delirious mania, and Bell’s mania. Karmacharya et al mentioned some distinctive symptoms of delirious mania and described some severe forms of familiar manic/psychotic symptoms, which could provide clues about delirious mania.ĭelirious mania is not recognized as a stand-alone diagnosis in the current nosology because many terms have been used over the years to describe patients presenting with mania, including excitement, delirium, and altered consciousness with/without catatonic symptoms. These patients presented specific features other than a combination of typical mania and delirium. ![]() Other studies have shown a high incidence of disorientation, confusion, or delirium among manic inpatients, and have noted that these patients tend to be hospitalized longer than are manic patients without these additional symptoms. Recognition of this syndrome is further complicated by the fact that many cases of delirious psychiatric patients are precipitated by medical or neurological conditions or use of psychoactive substances. There is no clear consensus on the clinical characteristics associated with delirious mania or guidelines for treatment. Here delirious mania is defined much more closely to the extremely severe group in the final stage, stage III mania described by Carlson and Goodwin. However, the description of delirious mania provided in Klerman’s classification was very similar to the delusional type defined earlier by Kraepelin, and it would be coded as bipolar I disorder, manic episode with psychotic feature in the DSM-IV. To better describe the range of severity, Klerman described the spectrum of mania in 5 stages: normal, neurotic, hypomanic, manic, and delirious. In 1921, Kraepelin categorized mania into 3 types: acute, delusional, and delirious. In 1849, Luther Bell, who is credited with providing the first comprehensive description of the syndrome, reported 40 patients with the condition out of 1700 admissions to McLean Hospital. The syndrome was first described by Calmiel in 1832. While delirious mania is not described in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition ( DSM-IV), it does exist through the evidence of clinical reports. Early recognition and aggressive treatment, especially with electroconvulsive therapy, can significantly reduce morbidity and mortality.Ĭoncurrence of delirium and mania is unusual. Delirious mania also has a close relationship with catatonia. 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. Conclusionsĭelirious mania is a potentially life-threatening but under-recognized neuropsychiatric syndrome. ![]() Delirious mania remitted within seven sessions of the electroconvulsive therapy (ECT). Delirium usually resolved faster than mania though not always the case. Two patients had two episodes of delirious mania. 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. To provide more information about this potentially life-threatening condition, we studied five patients with delirious mania. This condition still has no formal diagnostic classification. Little is known about the cause and psychopathology of delirious mania, a type of disorder where delirium and mania occur at the same time.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |