ECT in Delirious Mania: Case Series From Stony Brook

Out on PubMed, in JECT,  from clinicians at Stony Brook, is this paper:

An Examination of Electroconvulsive Therapy and Delivery of Care in Delirious Mania.

Reinfeld S, Yacoub A.J ECT. 2022 Apr 14. doi: 10.1097/YCT.0000000000000844. Online ahead of print.PMID: 35462389

The abstract is copied below:

Objectives: Delirious mania is a severe life-threatening syndrome, often misdiagnosed, and eminently treatable as a variant of catatonia. Our aim is to provide a comprehensive examination of electroconvulsive therapy (ECT) parameters and clinical features, as well as describe the delivery of care of the patients with delirious mania.

Methods: A retrospective study was conducted of the ECT records at Stony Brook University Hospital from years 2014 to 2021. We characterized demographic and clinical variables, including psychiatric diagnoses and ECT parameters of patients identified with delirious mania.

Results: We identified 8 cases (3 women) of delirious mania with 8 corresponding acute treatment series. The mean age was 43.2 ± 12.6 years (range, 23-59 years). There were a total of 55 sessions performed with an average of 6.9 ± 2.6 (range, 5-13); 45 (82%) were bilateral (bifrontal or bitemporal) and 10 (18%) were right unilateral electrode placement. In 40 (73%) of the sessions, a high-energy stimulus was used (>60%, or 302 millicoulombs). Seizure duration measured on electroencephalogram was 47.4 ± 25.9 seconds (range, 0-143 seconds). Motor seizure duration measured on electromyogram was 32.7 ± 14.9 seconds (range, 0-66 seconds). In 6 cases, ECT was delayed for 10 days, and patients were given inappropriate treatments. High-dose antipsychotics caused worsened aggression and hemodynamic instability requiring physical restraints in 50% of cases.

Conclusions: The clinical presentation of delirious mania remains poorly recognized, and its treatment is often delayed, which may result in negative outcomes. Bilateral ECT with high-energy dosing yielded a rapid remission of symptoms.

The paper is here.

And from the text:





This is a retrospective case series (n=8) and literature review (n=36) of this uncommon, but not rare, entity, delirious mania. The admonition to treat early with a potent, definitive form of ECT is well taken. All catatonia students/scholars will want to read this report in detail, ~ 10 minutes.
The multiple references/mentions of Max Fink are fitting tribute to the modern discoverer of the diagnosis.

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