Delerious Mania- Mania on Steroids

I just read a case report of a man with delerious mania. Yes it is rare but of interest isn't the delerious part but the mania. They pumped so much medication into this guy! Again- they'd rather he not die immefiately so they'll just medicate the hell out of him. I hope this medication course was short-term- and that Depakote was all he remained on- although Depakote is a serious drug, in my opinion. They followed him out one year and then lost touch. We can't know what indefinite high doses of Depakote and several other psychiatric medications did to him. He also received several ECT treatments- bilaterally. This is an extreme case with extreme treatments that resolved quickly. One wonders what the lasting effects will be.

The following quotes are from https://www.hindawi.com/journals/crips/2012/720354/ 

Case Report

Delirious Mania: Can We Get Away with This Concept? A Case Report and Review of the Literature

Rajshekhar Bipeta1 and Majeed A. Khan1,2

"He presented with an acute onset, third episode, of ten-day duration, characterized by assaultive behaviour, incessant and boastful talk, excessive planning, overfamiliarity, increased sexual desire, and decreased need for sleep and food. He was continuously reciting from the holy books; his relatives saw no coherence in it; it was totally misplaced. He engaged in continuous charity, without any signs of stopping it. The symptoms increased in severity within the previous six hours."

And...

"Rapport could not be established. He was extremely agitated, cursing everybody, including the doctors, and spitting at others. He even assaulted the hospital staff. He was turning everything upside-down, pushing the hospital furniture, jumping on the bed, dragging the mattresses, destroying all that which was in his reach. He had to be tied securely to the cot, but was even pulling the cot. He was making sexual advances towards fellow patients and hospital staff. These prolonged periods of extreme agitation would be followed by brief periods of sudden calmness and muteness."

And...

"He was diagnosed to have “bipolar disorder I, most recent episodemanic, severe withpsychotic features” as per Diagnostic and Statistical Manual of Mental Disorders (DSM IV criteria) [24]. He had associated features suggestive of delirium."

And...

"The elevated BP was managed with atenolol 50 mg/day. He was started on divalproex 1000 mg/day, haloperidol 20 mg/day, and lorazepam 4 mg/day. On day 2, as he was still very disturbed, olanzapine 10 mg i/m was administered. As there was no relief even after 8 hours, zuclopenthixol (Acuphase) 100 mg i/m was given, and loxapine (an antipsychotic drug) 25 mg/day was added."

And...

"By day 3, there was no relief; however, sleep was better. Loxapine was increased to 50 mg/day. By day 4, the aggression was better and clinically he was “much improved.” He was now sleeping from 6 to 7 hours per night. Divalproex was increased to 1500 mg/day, and haloperidol was discontinued.

"By day 5, as the BP was under control (130/90 mm Hg), bilateral ECT was started. The patient was maintaining the same improvement at day 7. He would quietly lie down, paranoia was coming down and he started accepting food and water. He was now amenable to suggestions and started calling others with respect. Loxapine was increased to 100 mg/day. By day 10, the patient had shown “marked improvement” and there was no evidence of any psychopathology. His self-care improved. His insight was relatively improved, the consciousness was clear and he was well oriented. Divalproex was increased to 2000 mg/day.

"A total of four sessions of ECT were administered. On day 12 (day of discharge), there was “marked improvement with no side effects.” He did not remember what had happened till one day back, for the previous nineteen days..."