Manic patients who are seen on a consultation service can have either primary or secondary mania. Primary mania results from bipolar disorder and can be exacerbated by a variety of medical conditions. Secondary mania results from a medical condition in the absence of underlying bipolar disorder. Secondary mania is more properly termed "mood disorder due to a general medical condition with manic features."
The DSM-IV diagnostic criteria for a manic episode requires elevated, expansive, or irritable mood for at least one week or any duration if the episode necessitates hospitalization as well as three or four of seven cardinal features of mania.
Delirium will differ from mania in that delirium has a waxing and waning course, altered consciousness, and visual hallucinations. In a manic episode, it would be more likely to see altered affect, hypersexuality, and pressured speech.
Catatonia is one condition that is diagnosed well out of proportion to its actual incidence. In some ways, that justifies giving it some coverage. Although catatonia occurs as a subtype of schizophrenia and in some affective disorders, it may also occur as a secondary catatonia from medical illness or other causes.
The key features of catatonia are stupor, immobility, mutism, catalepsy, and possible posturing. Care should be taken not to confuse catatonia with locked-in syndrome, Parkinson's disease, malignant hyperthermia, and elective mutism. Since a catatonic patient cannot provide a full history, it should be obtained from others.
Complications
The lack of movement of many catatonic patients keeps them bedridden, which can predispose them to the usual complications. Cardiovascular deconditioning is important because it leads to orthostatic intolerance, which can occur after only a few weeks of bed rest. Lack of motion increases the risk of deep venous thrombosis. Catatonic patients have an increased risk of aspiration pneumonia as well. Feeding of patients must not be overlooked and a nasogastric tube can be used for 30 days or less before instituting parental feeding.