title: Delirious mania and malignant catatonia: a report of 3 cases and review.
abstract: Delirious mania is often difficult to distinguish from excited catatonia. While some authors consider delirious mania a subtype of catatonia, the distinction between the two entities is important as treatment differs and effects outcome. It appears that as catatonia is described as having non-malignant and malignant states, the same division of severity may also apply to delirious mania. Non-malignant delirious mania meets the criteria for mania and delirium without an underlying medical disorder. The patients are amnestic, may lose control of bowel and bladder, but still respond to atypical antipsychotics and mood stabilizers. However, with increasing progression of the disease course and perhaps with an increasing load of catatonic features, delirious mania may convert to a malignant catatonic state (malignant delirious mania) which is worsened by antipsychotics and requires a trial of benzodiazepines and/or ECT. Three case reports are presented to illustrate the diagnostic conundrum of delirious mania and several different presentations of malignant catatonia.
authors.affiliation: Psychiatry Service, Veterans Affairs Medical Center, 1970 Roanoke Boulevard, Salem, VA 24153, USA. Mark.Detweiler1@va.gov
authors.forename: Mark B
authors.initials: MB
authors.lastname: Detweiler
authors.forename: Abhishek
authors.initials: A
authors.lastname: Mehra
authors.forename: Thomas
authors.initials: T
authors.lastname: Rowell
authors.forename: Kye Y
authors.initials: KY
authors.lastname: Kim
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bader
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage; D000928:Antidepressive Agents / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002389:Catatonia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003131:Combined Modality Therapy; D003693:Delirium / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology / Q000628:therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D005260:Female; D005500:Follow-Up Studies; D006212:Hallucinations / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012563:Schizophrenia, Paranoid / Q000209:etiology / Q000628:therapy; D014754:Violence / Q000523:psychology
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents