title: Electroconvulsive therapy in the treatment of delirious mania: a report of 2 patients.
abstract: Delirious mania also known as Bell mania is a syndrome of excitement, delirium, and psychosis, of acute onset. We report 2 patients who presented with acute onset of disorientation, aggressive behavior, double incontinence, grandiose ideas, and auditory hallucinations. Results of investigations to rule out organic etiology such as computed tomographic scan of brain, cerebrospinal fluid examination, and biochemical parameters were normal. Creatine kinase levels were only moderately elevated. A provisional diagnosis of delirious mania was made, and patients were empirically started on electroconvulsive therapy (ECT) session. Delirium resolved by the second ECT session, unmasking manic symptoms, and recovered completely at the end of sixth ECT session. Prophylactic lithium was started, and both patients continue to be in remission after 1 year. Differential diagnosis of the above clinical presentation includes neuroleptic malignant syndrome and malignant catatonia. Delirious mania is clinically important owing to the potential for diagnostic confusion and good response to ECTs.
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Danivas
authors.forename: Rishikesh V
authors.initials: RV
authors.lastname: Behere
authors.forename: Shivarama
authors.initials: S
authors.lastname: Varambally
authors.forename: Naren P
authors.initials: NP
authors.lastname: Rao
authors.forename: Ganesan
authors.initials: G
authors.lastname: Venkatasubramanian
authors.forename: Bangalore N
authors.initials: BN
authors.lastname: Gangadhar
mesh_terms: D000293:Adolescent; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy*; D002389:Catatonia / Q000628:therapy; D003693:Delirium / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D018020:Lithium Compounds / Q000627:therapeutic use; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D011618:Psychotic Disorders / Q000523:psychology; D018967:Risperidone / Q000627:therapeutic use; D055502:Secondary Prevention; D013577:Syndrome; D055815:Young Adult
chemical_list: D018692:Antimanic Agents; D006993:Hypnotics and Sedatives; D018020:Lithium Compounds; D018967:Risperidone; D008140:Lorazepam