Clinical response of clozapine as a treatment for delirious mania

Abstract

Delirious mania is an understudied psychiatric disorder with a mortality rate as high as 75%. Previous case studies suggest that electroconvulsive therapy (ECT) may be an effective treatment for delirious mania, though this procedure may not always be a viable option. We describe the case of a 20-year old patient, with no previous psychiatric history, who developed delirious mania over the course of four months. ECT was not a viable option for this patient due to his religious beliefs, so alternative treatment modalities were explored. After failing trials of risperidone and olanzapine, significant improvements in symptoms were exhibited with a trial of clozapine. We propose that clozapine may be an effective option in cases of delirious mania, when ECT is not a viable option. Additional research is still necessary to understand the pathology of this condition and potential treatment modalities.

Delirious mania: Presentation, pathogenesis, and management

“…12,13 Other cases have demonstrated swift improvement of symptoms after monotherapy with antipsychotics without a trial of benzodiazepines or electroconvulsive therapy (ECT); the exclusion of a sudden onset questions the validity of the diagnosis and promotes the use of less efficacious treatments. 14,15 Other reports have confirmed that the diagnosis is missed when certain symptoms are more predominant, such as a thought disorder (acute schizophrenia), grandiosity and delusional ideation (bipolar disorder [BD]), and less commonly assessed catatonic signs (ambitendency, automatic obedience). These symptoms are mistakenly attributed to the respective…”