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Clinical Case Conference   |    
Delirium Presenting as Mania in a Patient With End-Stage COPD
Samuel T. Wilkinson, M.D.; Shin-Bey Chang, M.D.; Teresa Foley, M.D.; John R. Lipsey, M.D.; Dean F. MacKinnon, M.D.
Am J Psychiatry 2014;171:821-824. doi:10.1176/appi.ajp.2013.12060810
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The authors report no financial relationships with commercial interests.

The authors thank Dr. Peter Rabins for his review of the manuscript and for discussing the major teaching points of the case and Dr. Todd Horiuchi for his help with the patient’s medical history.

From the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.; and the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore.

Address correspondence to Dr. MacKinnon (dfm@jhmi.edu).

Copyright © 2014 by the American Psychiatric Association

Received June 18, 2012; Revised October 01, 2012; Revised June 19, 2013; Accepted June 24, 2013.

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TABLE 1.Summary of Admissions and Treatmenta
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a ICU=intensive care unit; MMSE=Mini-Mental State Examination; JHH=Johns Hopkins Hospital.

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b The dates have been altered to preserve anonymity but are accurate relative to one another.

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c Where arterial blood results are provided, we have included pH, as a sensitive indicator of respiratory decompensation, and Paco2, as it trended upward independently of periods of acute respiratory decompensation. Normal arterial pH=7.35–7.45; normal Paco2=35–45 mmHg. We have omitted oxygen levels, as they added little useful information.

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d “As-needed” prescriptions for benzodiazepines have been omitted.

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References

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Peterson  JF;  Pun  BT;  Dittus  RS;  Thomason  JWW;  Jackson  JC;  Shintani  AK;  Ely  EW:  Delirium and its motoric subtypes: a study of 614 critically ill patients.  J Am Geriatr Soc 2006; 54:479–484
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Sandberg  O;  Gustafson  Y;  Brännström  B;  Bucht  G:  Clinical profile of delirium in older patients.  J Am Geriatr Soc 1999; 47:1300–1306
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MacKinnon  DF:  Bipolar disorder as maladaptive arousal: a behavioral model and evidence.  Ann N Y Acad Sci 2008; 1129:185–189
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