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CASE REPORT   

Minerva Psychiatry 2021 September;62(3):194-7

DOI: 10.23736/S2724-6612.21.02154-3

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Electroconvulsive therapy and haloperidol treatment of delirious mania in the youngest adolescent: a unique case report

Dinesh SANGROULA 1 , Mihika NEPAL 2, Rikesh CHAKRADHAR 3

1 Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA; 2 Chitwan Medical College, Bharatpur, Nepal; 3 Mayo Clinic, Rochester, MN, USA



Delirious mania (DM), characterized by a rapid onset delirium in a patient with acute mania, is associated with high morbidity and mortality. Despite the high prevalence of delirium in bipolar disorder (15-20%), DM is often underdiagnosed. It has not been included as a DSM diagnosis and no treatment guidelines exist. The management of DM is based on the evidence from case studies, mostly in adults and so far, a single case report has been published reporting DM and its management in children and adolescent (17 years old). We are reporting the youngest adolescent (16 years old) with a past history of bipolar 1 disorder who presented to the inpatient psychiatric unit for manic episode with delirium, catatonia, and psychosis. Full medical and neurological work-up including MRI, LP, and EEG did not reveal any significant findings and he was diagnosed with DM. The patient failed trials of multiple psychotropic medications including olanzapine, risperidone, quetiapine, lithium, and gabapentin but eventually responded to treatment with electroconvulsive therapy (ECT) and haloperidol. DM in adolescents is very difficult to diagnose and treat. Previous literature also indicated combination of typical antipsychotic with ECT and/or mood stabilizers being more efficacious in adolescents and young adults. This preliminary finding might guide for conducting larger controlled studies for more conclusive result.


KEY WORDS: Delirium; Electroconvulsive therapy; Mania; Child; Adolescent

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