“Delirious Mania.
The transition to delirious mania is marked by the appearance of confusion, more hallucinations, and a marked intensification of the symptoms seen in acute mania. A dreamlike clouding of consciousness may occur. Patients may mistake where they are and with whom. They cry out that they are in heaven or in hell, in a palace or in a prison; those around them have all changed—the physician is an executioner; fellow patients are secret slaves. Hallucinations, more commonly auditory than visual, appear momentarily and then are gone, perhaps only to be replaced by another. The thunderous voice of God sounds; angels whisper secret encouragements; the devil boasts at having the patient now; the patient’s children cry out in despair. Creatures and faces may appear; lights flash and lightning cracks through the room. Grandiose and persecutory delusions intensify, especially the persecutory ones. Bizarre delusions may occur, including Schneiderian delusions. Electrical currents from the nurses’ station control the patient; the patient remains in a telepathic communication with the physician or with the other patients.
Mood is extremely dysphoric and labile. Though some patients still are occasionally enthusiastic and jolly, irritability is generally quite pronounced. There may be cursing, and swearing; violent threats are made, and if patients are restrained they may spit on those around them. Sudden despair and wretched crying may grip the patient, only to give way in moments to unrestrained laughter.
Flight of ideas becomes extremely intense and fragmented. Sentences are rarely completed, and speech often consists of words or short phrases having only the most tenuous connection with the other. Pressure of speech likewise increases, and in extreme cases the patient’s speech may become an incoherent and rapidly changing jumble. Yet even in the highest grades of incoherence, where associations become markedly loosened, these patients remain in lively contact with the world about them. Fragments of nearby conversations are interpolated into their speech, or they may make a sudden reference to the physician’s clothing or to a disturbance somewhere else on the ward.
Hyperactivity is extreme, and behavior disintegrates into numerous and disparate fragments of purposeful activity. Patients may agitatedly pace from one wall to the other, jump to a table top, beat their chest and scream, assault anyone nearby, pound on the windows, tear the bed sheets, prance, twitter, or throw off their clothes. Impulsivity may be extreme, and the patient may unexpectedly commit suicide by leaping from a window.
Self-control is absolutely lost, and the patient has no insight and no capacity for it. Attempting to reason with the patient in delirious mania is fruitless, even assuming that the patient stays still enough for one to try. The frenzy of these patients is remarkable to behold and rarely forgotten. Yet in the height of delirious mania, one may be surprised by the appearance of a sudden calm. Instantly, the patient may become mute and immobile, and such a catatonic stupor may persist from minutes to hours only to give way again to a storm of activity. Other catatonic signs, such as echolalia and echopraxia and even waxy flexibility, may also be seen.”
