Delirious Mania in a 77-Year-Old Female

Delirium is associated with acute episodes of disturbances in attention and awareness along with changes to cognition, including memory deficits and disorientation. Delirious mania (DM) is an unusual phenomenon where symptoms of delirium co-exist with symptoms of mania such as elevated or irritable mood, grandiosity, agitation, and cognitive disorganization. There is no formal agreement upon clinical symptoms for DM, but it generally includes acute onset of confusion, poor orientation, excitation, restlessness, and delusions. DM was first identified in the mid-1800s by Dr. Luther Bell and has only been identified by case reports since. We investigated a 77-year-old woman who was found at a gas station in an altered mental state. Upon observation, she has symptoms consistent with DM, including inappropriate laughter, distraction and confusion. She was diagnosed with acute metabolic encephalopathy, but the presentation of DM was considered in the differential and remains a unique finding.