Delirious Mania

Jacobowski, Natalie; Heckers, Stephan; Bobo, William V.

doi:10.1097/01.pra.0000426324.67322.06

Cited by 51 publications

(29 citation statements)

References 68 publications

(105 reference statements)

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“…P. B. met some of the features of a patient with delirious mania as summarized by Jacobowski et al [3] and those described by other authors [8, 14, 16, 17]. A rapid onset of disorientation, fluctuating sensorium, altered level of consciousness, and severe cognitive dysfunction were noted.…”

Section: Discussionsupporting

confidence: 62%

“…The literature has recognized this concept in the form of clinical reports, but delirious mania has not been formally captured in a classification system such as the Diagnostic and Statistical Manual of Mental Disorders [2]. A reasonable definition of delirious mania is concurrence of rapid onset delirium, mania, and psychosis without association with a physical illness, prior toxicity, or another mental disorder [3]. Bell in 1849 identified that out of 1700 patients seen in McLean Asylum, USA, 40 patients presented with a “disease resembling some advanced stages of mania, and fever” [4].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, Jacobowski et al [3] reviewed the pathophysiology, diagnosis, and treatment strategies for delirious mania. Notably, features of delirium such as fluctuating sensorium, altered consciousness, disorientation, and catatonic features were the hallmark features described.…”

Section: Introductionmentioning

confidence: 99%

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Is the Concept of Delirious Mania Valid in the Elderly? A Case Report and a Review of the Literature

Maldeniya

Vasudev

2013

Case Reports in Psychiatry

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Delirious mania has been well recognized in the published literature and in the clinic. Over the years there has been refinement of understanding of its clinical features, course, and treatment. The literature suggests that delirious mania should be considered in individuals who present with a constellation of sudden onset delirium, mania, and psychosis. However, delirious mania is not recognized under a formal classification system nor are there any formal guidelines for its treatment. We, as such, question if the concept of delirious mania in the elderly is valid. We present a case of an elderly man with marked features of delirium with minimal manic or psychotic features who had a previous diagnosis of bipolar I disorder. On thorough clinical assessments no identifiable cause of his delirium was found. We therefore considered his presentation to be more likely due to delirious mania. Electroconvulsive therapy was considered and offered to which he responded very well. We invite the reader to consider whether delirious mania is a valid concept in the elderly, where features of delirium may be more prominent than manic or psychotic features.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

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Is the Concept of Delirious Mania Valid in the Elderly? A Case Report and a Review of the Literature

Maldeniya

Vasudev

2013

Case Reports in Psychiatry

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“…ECT is considered as a first line treatment in patients with delirious and severe mania, associated with life-threatening physical exhaustion [70, 71]. …”

Section: Introductionmentioning

confidence: 99%

The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features

Perugi

Medda

Toni³

et al. 2017

124

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Objective:We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression, mania, mixed state and catatonic features.Method:522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course. Responders and nonresponders were compared in subsamples of depressed and mixed patients. Descriptive analyses were reported for patients with mania and with catatonic features.Results:Of the original sample only 22 patients were excluded for the occurrence of side effects or consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression, 72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and global severity of the illness were the only statistically significant predictors of nonresponse.Conclusion:ECT resulted to be an effective and safe treatment for all the phases of severe and drug-resistant BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should be modified and, at least for the most severe patients, ECT should not be considered as a “last resort”.

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“…The most severe forms equalled a syndrome with many names: Bells mania, delirium grave, delirium acutum, delirious mania, acute deadly psychosis and lethal/malignant catatonia [16, 43–45]. Thus, the Danish psychiatrist Erik Strömgren (1909-1993), in a chapter on reactive psychosis, wrote [46]: “If there is the slightest sign to the condition developing into the life-threatening delirum acutum (…), electroshock treatment is indicated.”…”

Section: Introductionmentioning

confidence: 99%

Is schizophrenia disappearing? The rise and fall of the diagnosis of functional psychoses: an essay

Bergsholm

2016

BMC Psychiatry

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BackgroundThe categories of functional psychoses build on views of influential professionals. There have long been four main categories – affective, schizophrenic, schizoaffective/cycloid/reactive/polymorphic, and delusional/paranoid psychoses. The last three are included in “psychotic disorders”. However, this dichotomy and the distinctions between categories may have been over-estimated and contributed to lack of progress.Ten topics relevant for the diagnosis of functional psychoses1. The categories of functional psychoses have varied with time, place and professionals’ views, with moving boundaries, especially between schizophrenia and affective psychoses. 2. Catatonia is most often related to affective and organic psychoses, and paranoia is related to grandiosity and guilt, calling in question catatonic and paranoid schizophrenia. Arguments exist for schizophrenia being a “misdiagnosis”. 3. In some countries schizophrenia has been renamed, with positive consequences. 4. The doctrine of “unitary psychosis”, which included abnormal affect, was left in the second half of the 1800s. 5. This was followed by a dichotomy between schizophrenia and affective psychoses and broadening of the schizophrenia concept, whereas affective symptoms were strongly downgraded. 6. Many homogeneous psychoses with mixtures of schizophrenic and affective symptoms were described and related to “psychotic disorders”, although they might as well be affective disorders. 7. Critique of the extensive schizophrenia concept led to, in DSM-III and ICD-10, affective symptoms being exclusion criteria for schizophrenia and acceptance of mood-incongruent psychotic symptoms in affective psychoses. 8. However, affective symptoms are often difficult to acknowledge, diagnosis is often done on the basis of tradition and previous education, and patients’ affect characterized accordingly. 9. DSM-5 is up-dated with separate chapters for catatonia and psychotic symptoms, and removal of the subtypes of schizophrenia. However, time may be running out for categorical psychosis diagnoses, which may be replaced by continuum, spectrum, dimensional and research domain criteria, in line with new biological data 10. This is supported by treatment responses across categories.ConclusionThe time-consuming works on diagnosis of psychoses may have hampered progress. Chronic mood disorders may appear as schizophrenic or paranoid psychosis, end-stages like heart failure in heart diseases. This underscores the importance of early and optimal treatment of mood disorders.

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Delirious Mania

Cited by 51 publications

References 68 publications

Is the Concept of Delirious Mania Valid in the Elderly? A Case Report and a Review of the Literature

Is the Concept of Delirious Mania Valid in the Elderly? A Case Report and a Review of the Literature

The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features

Is schizophrenia disappearing? The rise and fall of the diagnosis of functional psychoses: an essay

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