The crossroad of delirium, mania, and catatonia: A case series on delirious mania

Sep 29, 2026

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Delirious mania (DM) is a rare, life-threatening neuropsychiatric syndrome combining manic excitation, catatonia, and fluctuating consciousness. Four patients with prior bipolar disorder were retrospectively evaluated for clinical features, investigations, comorbidities, treatment, and outcomes at a government mental hospital in Central India. All presented with acute agitation, grandiosity, disorientation, and catatonic features, with some metabolic and hypertension comorbidity. Clinical improvement occurred with lorazepam, sodium valproate, and atypical antipsychotics, while one required ECT, and stabilization followed targeted therapy within 7–14 days.

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Introduction

Cases

CASE SERIES The crossroad of delirium, mania, and catatonia: A case series on delirious mania Riya Gangwal, Vaibhav Sunil Nawale, Varchasvi Mudgal, Rahul Mathur Department of Psychiatry, MGM Medical College, Indore, Madhya Pradesh, India ABSTRACT Background: Delirious mania (DM) is a rare, life-threatening neuropsychiatric syndrome marked by the simultaneous presence of manic excitement, catatonia, and fluctuating consciousness. Although described extensively in Western literature, Indian reports remain limited. Cases: Four patients admitted to a government mental hospital in Central India were retrospectively evaluated for clinical features, investigations, comorbidities, treatment, and outcomes. All had a prior diagnosis of bipolar disorder and presented with acute agitation, grandiosity, disorientation, and catatonic features; two had past DM episodes. Comorbid hypertension and metabolic disturbances were noted in two cases. All showed clinical improvement with lorazepam, sodium valproate, and atypical antipsychotics, while one required electroconvulsive therapy for full resolution. Symptom stabilization occurred within 7–14 days of targeted treatment. Ethical approval and informed consent procedures were duly followed. Conclusion: DM should be considered in bipolar patients presenting with catatonia and delirium. Early recognition and multimodal treatment, including electroconvulsive therapy (ECT) when needed, ensure favorable outcomes. Key words: Bipolar disorder, catatonia, delirious mania, delirium, disorientation INTRODUCTION Delirious mania (DM) is a severe neuropsychiatric syndrome marked by the simultaneous presence of manic symptoms, delirium, and catatonia. First described in classical European psychiatry by Calmeil, Bell, and Kraepelin, the condition is characterized by acute onset of grandiosity, psychomotor agitation, confusion, and catatonic signs such as rigidity, mutism, or excitement. [1,2] Although Address for correspondence: Dr. Rahul Mathur, Department of Psychiatry, MGM Medical College, Indore ‑ 452 016, Madhya Pradesh, India E‑mail: [rahul.mathur068@gmail.com](rahul.mathur068@gmail.com) Submitted: 08‑Jul‑2025, Revised: 29‑Nov‑2025, Accepted: 30‑Nov‑2025, Published: 18‑Dec‑2025 | Access this article online | | | --- | --- | | Website:
[https://journals.lww.com/indianjpsychiatry](https://journals.lww.com/indianjpsychiatry) | Quick Response Code | | | | | DOI:
10.4103/indianjpsychiatry_696_25 | | international estimates suggest that 15%–30% of patients hospitalized for acute mania may display features consistent with DM, the syndrome is frequently under-recognized and under-reported. [3] Diagnostic difficulty arises because its manifestations overlap extensively with hyperactive delirium, acute psychosis, malignant catatonia, and treatment-resistant mania. In India, the situation is further complicated by limited awareness, the burden of medical comorbidities, and delays in seeking psychiatric care.[1] Patients with bipolar affective disorder appear to be particularly vulnerable to developing DM. Standard antimanic treatment alone is often insufficient because the delirious This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑NoDerivatives 4.0 License (CC BY‑NC‑ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. For reprints [contact:](contact: WKHLRPMedknow_reprints@wolterskluwer.com)[ WKHLRPMedknow_reprints@wolterskluwer.com](contact: WKHLRPMedknow_reprints@wolterskluwer.com) How to cite this article: Gangwal R, Nawale VS, Mudgal V, Mathur R. The crossroad of delirium, mania, and catatonia: A case series on delirious mania. Indian J Psychiatry 2025;67:1195‑8. Gangwal, et al.: Delirious mania: A case series and catatonic components require early identification and ta

FAQs

What characterizes delirious mania in bipolar patients?

Delirious mania is marked by the simultaneous presence of manic symptoms, delirium, and catatonia, including acute grandiosity, confusion, psychomotor agitation, and catatonic signs such as rigidity or mutism.

How were the four cases evaluated and what did they present with?

Four patients admitted to a government mental hospital were retrospectively evaluated for clinical features, investigations, comorbidities, treatment, and outcomes. All had prior bipolar disorder and presented with acute agitation, grandiosity, disorientation, and catatonic features; two had past DM episodes.

What treatments were associated with recovery, and when did stabilization occur?

Lorazepam, sodium valproate, and atypical antipsychotics led to clinical improvement in all cases, while one required electroconvulsive therapy for full resolution. Symptom stabilization occurred within 7–14 days of targeted treatment.

Sep 29, 2026

Uploaded by dabgoudw