Clinical characteristics and treatment responses of patients presenting with Delirious mania- A series of four cases

Background Delirious mania which was previously known as Bell's mania is a severe psychiatric syndrome characterized by the rapid onset of three principal clinical features- delirium, mania, and psychosis. It is a rare condition that involves severe incessant agitation, leading to a medical emergency. There are no standardized diagnostic guidelines. It has an acute onset, fluctuating course that alternates between psychosis, catatonic, manic features, and delirium with rapid progression of symptoms (i.e., hours or days). It is characterized by extreme psychomotor activity, disorientation, emotional lability, delusions and hallucinations. Very few cases have been reported from India hence making it imperative to study its clinical characteristics and possible treatment which can help in providing care to such patients in emergency settings. Case presentation: We describe the cases of four patients with delirious mania admitted to an inpatient psychiatric unit and discuss the demography, clinical features, investigations, treatment and course of illness during hospitalization of delirious mania. Conclusions Delirious mania is a severe but rare condition that involves severe incessant agitation, leading to a medical emergency. There is a high likelihood to misdiagnose these cases in the absence of diagnostic guidelines. Lack of recognition of this condition may lead to mismanagement of the course of illness. When manic excitement, psychosis, and delirium present concurrently, a diagnosis of delirious mania should be strongly considered. This case series will help clinicians in identifying cases of Delirious mania and providing treatment at early stages leading to a faster response and minimize morbidity.