Psychiatric Quarterly

, Volume 80, Issue 1, pp 23–40 | Cite as

Delirious Mania and Malignant Catatonia: A Report of 3 Cases and Review

  • Mark B. DetweilerEmail author
  • Abhishek Mehra
  • Thomas Rowell
  • Kye Y. Kim
  • Geoffrey Bader
Original Paper


Delirious mania is often difficult to distinguish from excited catatonia. While some authors consider delirious mania a subtype of catatonia, the distinction between the two entities is important as treatment differs and effects outcome. It appears that as catatonia is described as having non-malignant and malignant states, the same division of severity may also apply to delirious mania. Non-malignant delirious mania meets the criteria for mania and delirium without an underlying medical disorder. The patients are amnestic, may lose control of bowel and bladder, but still respond to atypical antipsychotics and mood stabilizers. However, with increasing progression of the disease course and perhaps with an increasing load of catatonic features, delirious mania may convert to a malignant catatonic state (malignant delirious mania) which is worsened by antipsychotics and requires a trial of benzodiazepines and/or ECT. Three case reports are presented to illustrate the diagnostic conundrum of delirious mania and several different presentations of malignant catatonia.


Delirious mania Catatonia Malignant catatonia Neuroleptic malignant syndrome Atypical antipsychotics 


  1. 1.
    Calmeil LF: Dictionnaire de medicine: ou, repertoire general des sciences medicales considerees sous le rapport theorique et pratique. 2edn. Paris, Bechet, 1832Google Scholar
  2. 2.
    Fink M: Delirious mania. Bipolar Disorders 1:54–60, 1999. doi: 10.1034/j.1399-5618.1999.10112.x PubMedCrossRefGoogle Scholar
  3. 3.
    Fink M, Taylor MA: The many varieties of catatonia. European Archives of Psychiatry and Clinical Neuroscience 251(1):I8–13, 2001. doi: 10.1007/PL00014200 PubMedGoogle Scholar
  4. 4.
    Friedman RS, Mufson MJ, Eisenberg TD, Patel MR: Medically and psychiatrically ill: The challenge of delirious mania. Harvard Review of Psychiatry 11:91–98, 2003. doi: 10.1080/10673220303960 PubMedCrossRefGoogle Scholar
  5. 5.
    Karmacharya R, England ML, Ongur D: Delirious mania: Clinical features and treatment response. Journal of Affective Disorders 109:312–316, 2008. doi: 10.1016/j.jad.2007.12.001 PubMedCrossRefGoogle Scholar
  6. 6.
    Bell L: On a form of disease resembling some advanced stages of mania and fever, but so contradistinguished form ordinarily observed or described combination of symptoms as to render it probable that it may be an overlooked and hitherto unrecorded malady. American Journal of Insanity 6:97–127, 1849Google Scholar
  7. 7.
    Lewis WB: A Text-Book of Mental Diseases: With special reference to the pathological aspects of insanity. London, Griffin, 1889Google Scholar
  8. 8.
    Dercum FX: A Clinical Manual of Mental Diseases. Philadelphia, London WB Saunders, 1917Google Scholar
  9. 9.
    Alzheimer A: Das delirum acutum. Monatsschrift fuer Psychiatrie und Neurologie 2:64–65, 1897Google Scholar
  10. 10.
    Berkley HJ: A Treatise on Mental Disease Based on the Lecture Course at the Johns Hopkins University 1899 and Designed for the Use of Practitioners and Students of Medicine. New York, D Appleton & Company, 1900Google Scholar
  11. 11.
    Binswanger O, Berger, H: Zur klinik und pathologischen anatomie der postinfectiosen und intoxicationspsychosen. European Archives of Psychiatry and Clinical Neuroscience 34:107–139, 1901Google Scholar
  12. 12.
    Church A, Peterson F: Nervous and Mental Diseases. Philadelphia London, WB Saunders Company, 1911 Google Scholar
  13. 13.
    Hoch A: Benign Stupors; A Study of a New Manic-Depressive Type. New York, Macmillan Publishing Co, Inc. 1–50:149–173, 1921Google Scholar
  14. 14.
    Bowers PE: Manual of psychiatry for the medical student and general practitioner. Philadelphia, Saunders, 1924Google Scholar
  15. 15.
    Stauder KH: Die todliche Katatonie. Archiv für Psychiatrie und Nervenkrankheiten 102:614–634, 1934. doi: 10.1007/BF01813829 CrossRefGoogle Scholar
  16. 16.
    Kraines SH: Bell’s mania. American Journal of Psychiatry 91:29–40, 1934Google Scholar
  17. 17.
    Mann SC, Caroff SN, Bleier HR, Welz WKR, Kling MA, Hayashida M: Lethal catatonia. American Journal of Psychiatry 143:1374–1381, 1986PubMedGoogle Scholar
  18. 18.
    Philbrick KL, Rummans TA. Malignant catatonia. The Journal of Neuropsychiatry and Clinical Neurosciences 6:1–13, 1994PubMedGoogle Scholar
  19. 19.
    Stromgren LS: ECT in acute delirum and related clinical states. Convulsive Therapy 13:10–17, 1997PubMedGoogle Scholar
  20. 20.
    Taylor MA, Fink M: Catatonia as a psychiatric classification: Home of its own. American Journal of Psychiatry 160:1233–1241, 2003. doi: 10.1176/appi.ajp.160.7.1233 PubMedCrossRefGoogle Scholar
  21. 21.
    Fink M, Taylor M: Catatonia: Subtype or syndrome in DSM? American Journal of Psychiatry. 163:1875–1876, 2006. doi: 10.1176/appi.ajp.163.11.1875 PubMedCrossRefGoogle Scholar
  22. 22.
    Kahlbaum K: Die Katatinie oder das Spannungssirresein, Berlin, a. Hirschwald (Translated: Kahlabuam K (1973) Catatonia. Johns Hopkins University Press, Baltimore, 1874Google Scholar
  23. 23.
    Pommepuy N, Januel D: La catatonie: resurgence d’un concept. Une revue de la litterature internationale. Encephale 27:481–492, 2002Google Scholar
  24. 24.
    Bush G, Fink M, Petrides G, Dowling F, Francis A: Catatonia. I. Rating scale and standardized examination. Acta Psychiatrica Scandinavica 93:129–136, 1996a. doi: 10.1111/j.1600-0447.1996.tb09814.x PubMedCrossRefGoogle Scholar
  25. 25.
    Peralta V, Cuesta MJ, Serrano JF, Mata I: The Kahlbaum syndrome: a study of its clinical validity, nosological status, and relationship with schizophrenia and mood disorder. Comprehensive Psychiatry 38:61–67, 1997. doi: 10.1016/S0010-440X(97)90055-9 PubMedCrossRefGoogle Scholar
  26. 26.
    Braunig P, Kruger S, Shagur G, Hoffler J, Borer I: The catatonia rating scale I: development, reliability, and use. Comprehensive Psychiatry 41:147–158, 2000. doi: 10.1016/S0010-440X(00)90148-2 PubMedCrossRefGoogle Scholar
  27. 27.
    Rogers D: Motor Disorder in Psychiatry: Towards a Neurological Psychiatry. Chichester UK, John Wiley & Sons, 1992Google Scholar
  28. 28.
    Taylor MA: Catatonia: A review of behavioral neurologic syndrome. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 3:48–72, 1990Google Scholar
  29. 29.
    Fink M. Catatonia: In: Trimble M, Cummings J (Eds), Contemporary Behavioral Neurology. Butterworth/Heinemann, Oxford, pp 289–309, 1997Google Scholar
  30. 30.
    Fink M, Taylor MA: Catatonia: A Clinician’s Guide to Diagnosis and Treatment. Cambridge, UK, Cambridge University Press, 2003Google Scholar
  31. 31.
    Van Den Eede F, Van Hecke J, Van Dalfsen A, Van den Bossche B, Cosyns P, Sabbe BG: The use of atypical antipsychotics in the treatment of catatonia. European Psychiatry 20:422–429, 2005. doi: 10.1016/j.eurpsy.2005.03.012 CrossRefGoogle Scholar
  32. 32.
    Nelson R, Furner S, Jesudason V, et al.: Fecal incontinence in Wisconsin nursing homes. Diseases of the Colon and Rectum 41:1226–1229, 1998. doi: 10.1007/BF02258218 PubMedCrossRefGoogle Scholar
  33. 33.
    Bond TC: Recognition of acute delirious mania. Archives of General Psychiatry 37:553–554, 1980PubMedGoogle Scholar
  34. 34.
    Gelenberg AJ: The catatonic syndrome. Lancet 1:1339–1341, 1976. doi: 10.1016/S0140-6736(76)92669-6 PubMedCrossRefGoogle Scholar
  35. 35.; referenced March 29, 2008
  36. 36.
  37. 37.
    Goldman SA: Lithium and neuroleptics in combination: the spectrum of neurotoxicity [corrected] Psychopharmacology bulletin 32:299–309. Erratum in: Psychopharmacology Bulletin 32:544, 1996Google Scholar
  38. 38.
    Markham-Abedi C, McNeely C, de Leon J: A case report with ziprasidone-induced catatonic symptoms. The Journal of Neuropsychiatry and Clinical Neurosciences 19:476–477, 2007. doi: 10.1176/appi.neuropsych.19.4.476 PubMedGoogle Scholar
  39. 39.
    Borovicka MC, Bond LC, Gaughan KM: Ziprasidone- and Lithium-induced Neuroleptic Malignant Syndrome. The Annals of Pharmacotherapy 40:139–142, 2005. doi: 10.1345/aph.1G470 PubMedCrossRefGoogle Scholar
  40. 40.
    Filice GA, McDougall BC, Ercan-Fang N, Billington CJ: Neuroleptic malignant syndrome associated with olanzapine. The Annals of Pharmacotherapy 32:1158–1159, 1998. doi: 10.1345/aph.18151 PubMedCrossRefGoogle Scholar
  41. 41.
    Berry N, Pradhan S, Sagar R, Gupta SK: Neuroleptic malignant syndrome in an adolescent receiving olanzapine-lithium combination therapy. Pharmacotherapy 23:255–259, 2003. doi: 10.1592/phco. PubMedCrossRefGoogle Scholar
  42. 42.
    Tolsma FJ: The syndrome of acute pernicious psychosis. Psychiatria, Neurologia, Neurochirurgia 70:1–21, 1967PubMedGoogle Scholar
  43. 43.
    Chrisstoffels J, Thiel JH: Delirium acutum, a potentially fatal condition in the psychiatric hospital. Psychiatria, Neurologia, Neurochirurgia 73:177–187, 1970PubMedGoogle Scholar
  44. 44.
    Fox FL, Bostwick JM: Propofol sedation of refractory delirious mania. Psychosomatics 38:288–290, 1997PubMedGoogle Scholar
  45. 45.
    Shulack NR: Sudden “exhaustive” death in excited patients. The Psychiatric Quarterly 18:3–12, 1944. doi: 10.1007/BF01569018 CrossRefGoogle Scholar
  46. 46.
    Shulack NR: Exhaustion syndrome in excited psychotic patients. American Journal of Psychiatry 102:466–475, 1946Google Scholar
  47. 47.
    Lingjaerde O: Contributions to the study of schizophrenia and the acute malignant deliria. Journal of the Oslo City Hospitals 14:43–83, 1963Google Scholar
  48. 48.
    Bush G, Fink M, Petrides G, Dowling F, Francis A: Catatonia. II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatrica Scandinavica 93:137–43, 1996b. doi: 10.1111/j.1600-0447.1996.tb09815.x PubMedCrossRefGoogle Scholar
  49. 49.
    Arnold OH, Stepan H: Untersuchungen zur Frage der akuten todlichen Katatonie. Wiener Zeitschrift fur Nervenheilkunde und Deren Grenzgebiete 4:235–258, 1552Google Scholar
  50. 50.
    Sedivec V: Psychoses endangering life. Ceskoslovenská psychiatrie 77:38–41, 1981PubMedGoogle Scholar
  51. 51.
    Hafner H, Kasper S: Akute lebensbedrohliche Katatonie: Epdemiologische und Klinische Befunde. Nervenzart 53:385–394, 1982Google Scholar
  52. 52.
    Beckmann H, Franzek E, Stöber G: Genetic heterogeneity in catatonic schizophrenia: A family study. American Journal of Medical Genetics 67:289–300, 1996. doi:10.1002/(SICI)1096-8628(19960531)67:3<289::AID-AJMG5>3.0.CO;2-IGoogle Scholar
  53. 53.
    Stöber G, Franzek E, Lesch KP, Beckmann H: Periodic catatonia: A schizophrenic subtype with major gene effect and anticipation. European Archives of Psychiatry and Clinical Neuroscience 245(3):135–141, 1995. doi: 10.1007/BF02193085 PubMedCrossRefGoogle Scholar
  54. 54.
    Stöber G, Saar K, Rüschendorf F, Meyer J, Nürnberg G, Jatzke S, Franzek E, Reis A, Lesch KP, Wienker TF, Beckmann H: Splitting schizophrenia: Periodic catatonia-susceptibility locus on chromosome 15q15. American Journal of Human Genetics 67:1201–1207, 2000PubMedGoogle Scholar
  55. 55.
    Huang TL: Lorazepam and diazepam rapidly relieve catatonic signs in patients with schizophrenia. Psychiatry and Clinical Neurosciences 59(1):52–55, 2005. doi: 10.1111/j.1440-1819.2005.01331.x PubMedCrossRefGoogle Scholar
  56. 56.
    Martényi F, Metcalfe S, Schausberger B, Dossenbach MR: An efficacy analysis of olanzapine treatment data in schizophrenia patients with catatonic signs and symptoms. The Journal of Clinical Psychiatry 62(2):25–27, 2001PubMedGoogle Scholar
  57. 57.
    Kraepelin E: Manic-Depressive Insanity and Paranoia. Edinburgh, E & S Livingstone, pp 70–74, 1921Google Scholar
  58. 58.
    Whalley N, Diaz P, Howard J: Neuroleptic malignant syndrome associated with the use of quetiapine. The Canadian Journal of Hospital Pharmacy 52:112, 1999Google Scholar
  59. 59.
    Powers P, Scott DT, Waziri R: Hyperpyrexia in catatonic states. Diseases of the Nervous System 37:359–361, 1976PubMedGoogle Scholar
  60. 60.
    O’Toole JK, Dyck G: Report of psychogenic fever in catatonia responding to electroconvulsive therapy. Diseases of the Nervous System 38:852–853, 1977PubMedGoogle Scholar
  61. 61.
    Pruett JR, Rizvi ST: A16-year-old girl with excited catatonia treated with low-dose oral Lorazepam. Journal of Child and Adolescent Psychopharmacology 15(6):1005–1010, 2005. doi: 10.1089/cap.2005.15.1005 PubMedCrossRefGoogle Scholar
  62. 62.
    Manjunatha N, Saddichha S, Khess CR: Idiopathic recurrent catatonia needs maintenance lorazepam: case report and review. The Australian and New Zealand Journal of Psychiatry 41:625–627, 2007. doi: 10.1080/00048670701400032 PubMedCrossRefGoogle Scholar
  63. 63.
    Stanley AK, Hunter J: Possible neuroleptic malignant syndrome and quetiapine. The British Journal of Psychiatry 176:497, 2000. doi: 10.1192/bjp.176.5.497-a PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Mark B. Detweiler
    • 1
    • 2
    Email author
  • Abhishek Mehra
    • 3
  • Thomas Rowell
    • 3
  • Kye Y. Kim
    • 1
    • 2
  • Geoffrey Bader
    • 1
    • 2
  1. 1.Psychiatry ServiceVeterans Affairs Medical CenterSalemUSA
  2. 2.Department of Psychiatry and Neurobehavioral SciencesThe University of Virginia CharlottesvilleUSA
  3. 3.Carilion-University of Virginia Roanoke-Salem Psychiatric Medicine Residency ProgramUniversity of VirginiaSalemUSA

Personalised recommendations