Delirious mania is a severe but often underrecognized syndrome characterized by rapid onset of delirium, mania, and psychosis, with no identifiable organic cause .
After considering delirious mania and his lack of response to standard therapies, including lorazepam, we hypothesized that the resolution was due to the discontinuance in antihypertensive medications and to the subsequent normalization of blood cerebral perfusion.
showed the typical features of delirious mania: rapid onset of disorientation, fluctuating sensorial patterns, altered level of consciousness, intense excitement, emotional lability, disorganized rambling speech, hallucinations, delusions, subtotal insomnia, and bizarre and disorganized behaviours, in the absence of identifiable organic causes.
Unfortunately, delirious mania lacks formal diagnostic criteria, and most descriptions of this syndrome are from case series, with different courses and nonunivocal etiology.
After treating a young woman with delirious mania, we were compelled to comment on the case report "Confused and nearly naked after going on spending sprees" (Cases That Test Your Skills, Current Psychiatry.
The patient received a diagnosis of delirious mania, with the underlying mechanism being severe catatonia.
Diagnosing and treating delirious mania in our patient was challenging.
Klerman described a progression from normal happiness or joy through cyclothymic personality, nonpsychotic hypomania, psychotic mania and delirious mania
Resistant depression, psychotic depression, delirious mania
, malignant catatonia, depression in the elderly, and schizophrenia are a few of the indications.
Our working diagnosis, therefore, was bipolar disorder with features of delirious mania.
Delirious mania was first described by Luther Bell in 1849 and is characterized by an acute and simultaneous onset of mania--severe insomnia, poor judgment, grandiosity, excitement, emotional lability, bizarre hallucinations, and delusions--and delirium--altered consciousness, disorientation, and confusion.
Several theories try to clarify the underlying etiology of delirious mania. Jacobowski et al(9) summarized the etiology and proposed that it is: