Electroconvulsive Therapy and Delirious Catatonic Mania

Tegin, Cuneyt; Kalayil, George; Lippmann, Steven

doi:10.1097/yct.0000000000000431

Cited by 6 publications

(4 citation statements)

References 4 publications

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“…Wachtel et al 20 1 case There were reported 5 ECT sessions until remission (no comment on electrode placement). Tegin et al 21 1 case There were 6 sessions of bilateral ECT with complete remission. Melo and Serra 22 1 case There were 8 sessions of ECT with complete resolution.…”

Section: Publicationmentioning

confidence: 99%

“…Because catatonic signs like excessive hyperactivity, impulsivity, combativeness, negativism, stereotypy, posturing, grimacing, and echophenomena accompany delirious mania, a lorazepam challenge can be useful for diagnostic clarification. 1,13 Many of the case reports 3,[15][16][17][18][19][20][21][22] published over the last 20 years report treatment with ECT. A brief course of 4 to 12 sessions until remission of symptoms was the typical regimen of treatment.…”

mentioning

confidence: 99%

“…Many of the case reports 3,15–22 published over the last 20 years report treatment with ECT. A brief course of 4 to 12 sessions until remission of symptoms was the typical regimen of treatment.…”

mentioning

confidence: 99%

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An Examination of Electroconvulsive Therapy and Delivery of Care in Delirious Mania

Reinfeld¹,

Yacoub²

2022

J ECT

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Objectives: Delirious mania is a severe life-threatening syndrome, often misdiagnosed, and eminently treatable as a variant of catatonia. Our aim is to provide a comprehensive examination of electroconvulsive therapy (ECT) parameters and clinical features, as well as describe the delivery of care of the patients with delirious mania.Methods: A retrospective study was conducted of the ECT records at Stony Brook University Hospital from years 2014 to 2021. We characterized demographic and clinical variables, including psychiatric diagnoses and ECT parameters of patients identified with delirious mania. Results:We identified 8 cases (3 women) of delirious mania with 8 corresponding acute treatment series. The mean age was 43.2 ± 12.6 years (range, 23-59 years). There were a total of 55 sessions performed with an average of 6.9 ± 2.6 (range, 5-13); 45 (82%) were bilateral (bifrontal or bitemporal) and 10 (18%) were right unilateral electrode placement. In 40 (73%) of the sessions, a high-energy stimulus was used (>60%, or 302 millicoulombs). Seizure duration measured on electroencephalogram was 47.4 ± 25.9 seconds (range, 0-143 seconds). Motor seizure duration measured on electromyogram was 32.7 ± 14.9 seconds (range, 0-66 seconds). In 6 cases, ECT was delayed for 10 days, and patients were given inappropriate treatments. High-dose antipsychotics caused worsened aggression and hemodynamic instability requiring physical restraints in 50% of cases. Conclusions:The clinical presentation of delirious mania remains poorly recognized, and its treatment is often delayed, which may result in negative outcomes. Bilateral ECTwith high-energy dosing yielded a rapid remission of symptoms.

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Section: Publicationmentioning

confidence: 99%

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confidence: 99%

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An Examination of Electroconvulsive Therapy and Delivery of Care in Delirious Mania

Reinfeld¹,

Yacoub²

2022

J ECT

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“…There were no systematic reviews, meta analyses, or randomized control trials (RCTs). The 12 articles included in this review consist of 7 individual case reports, 4 case series, and 1 retrospective chart review that describe a total of 36 cases (Table, 1,2,5,17,[19][20][21][22][23][24][25][26] page 30).…”

Section: Delirious Maniamentioning

confidence: 99%

Delirious mania: Presentation, pathogenesis, and management

Reinfeld

2023

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D elirious mania is a syndrome characterized by the acute onset of severe hyperactivity, psychosis, catatonia, and intermittent confusion. While there have been growing reports of this phenomenon over the last 2 decades, it remains poorly recognized and understood. 1,2 There is no widely accepted nosology for delirious mania and the condition is absent from DSM-5, which magnifies the difficulties in making a timely diagnosis and initiating appropriate treatment. Delayed diagnosis and treatment may result in a detrimental outcome. 2,3 Delirious mania has also been labeled as lethal catatonia, specific febrile delirium, hyperactive or exhaustive mania, and Bell's mania. 2,4,5 The characterization and diagnosis of this condition have a long and inconsistent history (Box, 1,6-11 page 28).Delirious mania continues to be met with incertitude in clinical practice, and numerous inconsistencies have been reported in the literature. For example, some cases that have been reported as delirious mania had more evidence of primary delirium due to another medical condition or primary mania. 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

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