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.
Electroconvulsive therapy has been a novel treatment for about half a century, effective for severe psychiatric conditions. Over the years, the treatment has been refined with the addition of anesthesia. Different inducing agents have been used in clinical practice over the last few decades including propofol, methohexital, and etomidate. Previous literature rarely mentions seizures soon after induction with etomidate and typically only in anesthesia literature. We describe 2 cases with different demographics, diagnosis, and treatment that had seizures with the use of etomidate as an inducing agent.
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