A Case of Delirious Mania Treated with Electroconvulsive Therapy

Abstract

(1) Background: Delirious mania is a neuropsychiatric condition characterized by the rapid onset of delirium, psychosis, and mania. Due to the presence of catatonic signs and symptoms, some authors considered this syndrome to be a specific excited catatonia subtype. Usually, delirious mania is responsive to intravenous benzodiazepines (BZDs) or to electroconvulsive therapy (ECT). (2) Methods: In the present study, we describe the case of a 64-year-old woman with a diagnosis of recurrent major depressive disorder. We assessed the severity of the clinical picture and the response to ECT treatment with the Bush–Francis Catatonia Rating Scale (BFCRS). (3) Results: After eleven sessions of ECT, the patient presented a reduced BFCRS total score, with a resolution of the autonomic abnormalities (temperature, respiratory, and heart rate). (4) Conclusions: These data demonstrate how important it is to diagnose this syndrome as soon as possible to set up an effective therapy, avoiding the use of antipsychotic drugs and preventing potentially fatal complications. The initial administration of BZDs IV and the subsequent ECT application, associated with intensive care of life-threatening general medical conditions, guaranteed us a good level of efficacy in obtaining a complete resolution of the clinical picture.

Clinical Characteristics and Treatment Responses of Patients in Delirious Mania: A Case Series

“…The haematological and neuroimaging findings were within normal range, except in one case, where there was comorbidity of pulmonary tuberculosis. There was a good response to intravenous Lorazepam or MECT in all cases, similarly to that found in other studies [ 17 , 18 ]. MECT yielded drastic improvement whenever used.…”

“…A clinician should strongly consider the diagnosis of Delirious mania whenever delirium, mania, and psychosis are present concurrently; the additional presence of catatonia further bolsters the confirmation of DM [ 19 ]. In cases where the risk of harm to self or others is high, benzodiazepines and/or MECT may provide immediate relief [ 3 , 18 ].…”

“…In cases where the risk of harm to self or others is high, benzodiazepines and/or MECT may provide immediate relief [3,18].…”