A mistake in diagnosing delirious mania can be fatal: Case report

Delirious mania (DM) is a severe psychiatric condition having rapid onset of delirium, mania, and psychosis. It is an emergency condition as it has acute onset and is characterized by extreme hyperactivity.

In a case reported, a 40-year-old male patient was admitted to a psychiatric clinic. Over a period of three days, he exhibited excessive talkativeness, increased activity, insomnia, irritability and aggression, hypersexuality, and unexplained anxiety. At the time of his hospital admission, the patient displayed signs of disorientation in space and time and experienced blackouts. On examination, he mimicked the doctor’s behavior, while repeating the words he was told.

Another three patients aged 22, 35, and 38 years were admitted to the same clinic with similar symptoms. During examination, none showed any medical reasons for being disoriented not presented any pronounced behavioral disorders, even though they shared a history of manic episodes. Based on the medical history data and the results of diagnostic tests, the patients were diagnosed with acute delirious mania. The condition is a severe psychiatric syndrome, the clinical signs of which develop rapidly and force the patient to require emergency care. An erroneous diagnosis may result in a fatal outcome.

This case report adds to the available medical literature on the clinical features, risk factors, investigations to be ordered, and treatment of DM. This information will be of help to clinicians in improving their knowledge and modifying their treatment methods in order to achieve a faster response. 

There is a high likelihood of misdiagnosing Delirious mania (DM) in the absence of diagnostic guidelines. There should be an active search for the underlying aetiology in all cases of Delirious mania (DM). Atypical antipsychotics and mood stabilizers may be used to treat less severe forms of Delirious mania (DM). Modified electric convulsive treatment and intravenous benzodiazepines elicit a good response.

Reference:

Sahu R.K., Rana A., Clinical Characteristics and Treatment Responses of Patients in Delirious Mania: A Case Series, Consortium Psychiatricum, https://doi.org/10.17816/CP15501