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According to Dunayevich and Keck symptoms in DM are similar to schizophrenia [13], with presence of severe anxiety, frenzied activity, and incoherence [15]. [15] E. Dunayevich and P. E. Keck, “Prevalence and description of psychotic features in bipolar mania,” Current Psychiatry Reports, vol. 2, no. 4, pp. 286–290, 2000. Almost all patients with DM exhibit signs of catatonia [2, 3, 16]. Taylor and Fink theorised DM as a form of catatonia because of the presence of catatonic features, and good response to ECT [2, 17]. 16. Str?mgren LS: ECT in acute delirium and related clinical states. Convuls Ther 1997, 13:10–17. 17。M. A. Taylor and M. Fink, “Catatonia in psychiatric classification: a home of its own,” The American Journal of Psychiatry,vol. 160, no. 7, pp. 1233–1241, 2003. DM was initially thought to be an uncommon syndrome,as many cases used to go unrecognized. Though the concept of DM is now documented in literature, not much is known about its aetiopathogenesis [18] and core clinical features. 17. Friedman RS, Mufson MJ, Eisenberg TD, Patel MR: Medically and psychiatrically ill: the challenge of delirious mania. Harv Rev Psychiatry.2003, 11:91–98. 18. The most recent work on DM is by Lee et al. in 2012. They comment that DM does not find mention in the current nosology as a separate diagnosis. The authors present five cases of DM who had “concurrent manic and delirious symptoms during hospitalization, and medical workup failed to uncover an organic cause for either mania or delirium.” Bo-Shyan Lee, Si-Sheng Huang, Wen-Yu Hsu,et al.Clinical features of delirious mania: a series of five cases and a brief literature review.BMC Psychiatry 2012, 12:65 They caution that in view of high medical comorbidity in BD patients, there is a risk of missing DM. The authors conclude that BD patients are at increased risk of delirium, with a tendency for recurrence. They recommend early recognition and aggressive management, particularly with ECT [23]. [23