Abstract
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.
Highlights
Delirious mania has been described as a clinical syndrome since 1832 by Calmeil [1]
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]
No identifiable causes of delirium were discovered; we considered a diagnosis of delirious mania even in the absence of florid manic and psychotic features
Summary
Delirious mania has been described as a clinical syndrome since 1832 by Calmeil [1]. 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]. Weintraub and Lippman [11] published one of the few case reports of delirious mania in an older population Their case report describes two cases of elderly patients who initially presented in a state of delirium and were noted to have distinct manic features during the latter part of their inpatient stay. They recommended that differential diagnosis for someone who presents with features of confusion, disorientation, and perceptual changes should include delirious mania, so in the elderly [11]. Based on the relative paucity of manic and psychotic features in his presentation, we invite the reader to question whether the classical description of delirious mania is a valid clinical concept in the elderly
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