Delirious mania

To define the characteristics of delirious mania.

A list of patients exhibiting both delirium and mania admitted to an academic psychiatric treatment unit of a tertiary care medical center was maintained for 6 years. A literature review for the terms 'delirium' and 'bipolar disorder' was undertaken.

Few articles identify the syndrome. Most cite Bell (On a form of disease resembling some advanced stages of mania and fever. Am J Insanity 1849; 6: 97-127) as the first observer and Bond (Recognition of acute delirious mania. Arch Gen Psychiatry 1980; 37: 553 554) as the most recent. Fourteen instances were identified in the case list. Delirious mania is a syndrome of the acute onset of the excitement, grandiosity, emotional lability, delusions, and insomnia characteristic of mania, and the disorientation and altered consciousness characteristic of delirium. Almost all patients exhibited signs of catatonia. Bond (1980) recommends lithium and a neuroleptic combination as the treatment. In the present series, electroconvulsive therapy was found to be safe and rapidly effective, with all cases responding within three treatments and requiring less than six treatments in the course. The rapidity of response is the same as that of patients with catatonia.

Delirious mania warrants specific identification in the diagnostic nomenclature. The distinction between delirious mania and the excited or malignant forms of catatonia requires study.