title: Delirious mania: clinical features and treatment response.
abstract: OBJECTIVE
  To examine clinical characteristics and treatment responses of patients presenting with delirium and mania to a psychiatric inpatient unit.
  
  
  METHODS
  Chart review of 16 cases admitted to McLean Hospital with delirium and mania was conducted. We examined the demographics, psychiatric symptoms, clinical course, and response to treatment with medications and electroconvulsive therapy (ECT).
  
  
  RESULTS
  Patients with delirium and mania had negative medical and neurological work-ups and were more likely to be younger, female and with a prior diagnosis of bipolar disorder. Sudden onset of symptoms, incontinence/inappropriate toiletting, and denudativeness are distinctive features of the syndrome. Consistent and significant benefit was seen with ECT. In many cases, high dose benzodiazepines were helpful. In a small number of cases, clozapine was also beneficial but this effect took an average of four weeks to be seen, while atypical antipsychotics, lithium and valproate produced variable results and took an average of three and a half weeks to work, if at all. Typical antipsychotics and anticholinergic drugs led to clinical worsening.
  
  
  CONCLUSIONS
  Most patients were on more than one medication and hence treatment responses cannot be definitively ascribed to a specific intervention. Studies of larger groups of such patients in different clinical settings need to be done to confirm our observations.
  
  
  CONCLUSIONS
  Delirious mania is a severe psychiatric syndrome which can be accurately recognized and effectively treated. The definitive treatment for this condition is ECT. In cases where ECT is not available, high dose benzodiazepines should be used. Clozapine, quetiapine, lithium and valproate cannot be considered first-line treatments and these medications take an unacceptably long time to work even when helpful; typical antipsychotics and anticholinergic drugs should be avoided.
authors.affiliation: Schizophrenia & Bipolar Disorder Program, McLean Hospital, Belmont, MA 02478, USA. karmacharya@mcb.harvard.edu <karmacharya@mcb.harvard.edu>
authors.forename: Rakesh
authors.initials: R
authors.lastname: Karmacharya
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: England
authors.forename: Dost
authors.initials: D
authors.lastname: Ongür
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D003024:Clozapine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003693:Delirium / Q000453:epidemiology*; D004565:Electroconvulsive Therapy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine