Delirious mania: clinical features and treatment response.
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.
Karmacharya
Rakesh
R
Schizophrenia & Bipolar Disorder Program, McLean Hospital, Belmont, MA 02478, USA. karmacharya@mcb.harvard.edu <karmacharya@mcb.harvard.edu>
England
Mary Lou
ML
Ongür
Dost
D
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
D014150:Antipsychotic Agents; D003024:Clozapine