Postpartum delirious mania in a patient with diagnosis of bipolar disorder after cesarean delivery: a case report

Background Postpartum depressive episodes are common. Patients with bipolar disorder (BD) may also experience manic or mixed episodes postpartum, but cases of delirious mania (DM)—characterized by rapidly evolving delirium, mania, and may involve psychotic symptoms—are rarely reported. Given its severity, frequent underdiagnosis, and life-threatening risks, a thorough exploration of its clinical features, potential risk factors, and treatment strategies can aid clinicians in early recognition and intervention, thereby improving patient outcomes. Case presentation We report a rare case of postpartum delirium with manic features. The patient was a 27-year-old woman with a history of bipolar disorder type I. She underwent amniocentesis at 19 weeks of her first pregnancy and developed a manic episode with psychotic symptoms on the third postoperative day. She improved rapidly after receiving antipsychotic and sedative medications. This presentation occurred on day 2 following her second cesarean section. She exhibited a series of agitated symptoms including motor restlessness, verbose speech, auditory hallucinations, mood swings, irritability, aggressive behavior, and abnormal excitement. She also demonstrated delirious mania features such as disorientation in time and place, inattention, memory impairment, and urinary incontinence. Initial emergency department treatment with sodium valproate, quetiapine, and propofol proved ineffective. After admission, treatment was switched to sodium valproate and olanzapine, yet outcomes remained suboptimal. However, following electroconvulsive therapy (ECT), symptoms rapidly improved. During regular follow-up visits over 6 months post-discharge, the patient remained free of manic or delirious symptoms while continuing olanzapine and sodium valproate therapy, with overall satisfactory outcomes. Conclusion Women with bipolar disorder and multiple childbirths may have an increased risk of delirious manic episodes. Electroconvulsive therapy (ECT) is an effective treatment option for rapid relief. Valproate and olanzapine can serve as maintenance therapy regimens.