Introduction: A serious but underdiagnosed neuropsychiatric illness called delirious mania is described by the sudden onset of delirium, mania, and psychosis. Demyelination is the term used to describe the loss of myelin while axons are largely preserved. Depending on the site of insult, various neuropsychiatric manifestations may appear. We are discussing a case that was presented initially as mania but after a proper evaluation it was found to be a case of delirious mania along with multiple demyelinating foci in brain imaging, which had an impact on the presentation of this case.
Case description: This is a case of 19-year-old man presented with complaints of talkativeness, tall claims, increasingly bizarre, and disorganized behavior with intermittent restlessness for the last 2 months. After a few trials with psychotropics, the patient started showing improvement with a combination of mood stabilizers and antipsychotics.
Conclusion: Recent reports suggest that delirious mania may constitute up to 15% of all acute mania cases. When delirious mania is unrecognized or improperly treated, it can progress rapidly in severity and can become life-threatening. Like in our case, patients presenting with manic symptoms should also be properly evaluated for other underlying pathology which may have a significant impact on patient's well-being.
Calmeil LF. Dictionnaire de Medicine: Our repertoire general des sciences medicales considerees sous le rapport theorique et pratique. Paris, France: Bechet, 1832. Accessed on: 27 October 2022.
Bell L. On a form of disease resembling some advanced stages of mania and fever, but so contradistinguished from any ordinary observed or described combination of symptoms as to render it probable that it may be overlooked and hitherto unrecorded malady. Am J Insanity 1849;6(2):97–127. https://doi.org/10.1176/ajp.6.2.97.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edn (DSM-5). Arlington, VA: American Psychiatric Association, 2013. Accessed on: 27 October 2022.
World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992. Accessed on: 27 October 2022.
Carlson GA, Goodwin FK. The stages of mania: A longitudinal analysis of the manic episode. Arch Gen Psychiatry 1973;28(2):221–228. DOI: 10.1001/archpsyc.1973.01750320053009.
Ritchie J, Steiner W, Abrahamowicz M. Incidence of and risk factors for delirium among psychiatric inpatients. Psychiatr Serv 1996;47(7):727–730. DOI: 10.1176/ps.47.7.727.
Friedman RS, Mufson MJ, Eisenberg TD, et al. Medically and psychiatrically ill: The challenge of delirious mania. Harv Rev Psychiatry 2003;11(2):91–98. DOI: 10.1080/10673220303960.
Bell L. On a form of disease resembling some advanced stage of mania and fever. Am J Insanity 1849;6:97–127. https://doi.org/10.1176/ajp.6.2.97.
Mann SC, Caroff SN, Bleier HR, et al. Lethal catatonia. Am J Psychiatry 1986;143(11):1374–1381. DOI: 10.1176/ajp.143.11.1374.
Larson EW, Richelson E. Organic causes of mania. Mayo Clin Proc 1988;63(9):906–912. DOI: 10.1016/S0025-6196(12)62694-9.
Reinfeld S, Yacoub A. A case of delirious mania induced by COVID-19 treated with electroconvulsive therapy. J ECT 2021;37(4):e38–39. DOI: 10.1097/YCT.0000000000000789.
Lee BS, Huang SS, Hsu WY, et al. Clinical features of delirious mania: A series of five cases and a brief literature review. BMC Psychiatry 2012;12(1):1–9. DOI: 10.1186/1471-244X-12-65.