Reply to comments on “Delirious mania or excited catatonia: Diagnostic and management issues in a post-partum woman”

We are thankful to the authors for keenly reading our work. The points raised by the authors are very pertinent and at the outset, we acknowledge that in accordance to the publication guidelines only the most essential information was provided to ensure brevity. Further, Krauthammer and Klerman’s (1978)[1] conceptualization of secondary mania excludes patients with a history of manic depressive or other affective illness and those with manic syndrome with confusional states. Additionally, the presence of family history of an affective illness is an exclusionary criterion for secondary mania. The secondary mood syndrome of ICD-11 also excludes delirium and hence it was not considered in the index case. The C-L psychiatry team initially evaluated the patient in the obstetric ward and possibility of delirium was kept in view of clinical features and underlying metabolic abnormalities. However, due to florid psychopathology, application of mini mental state examination (MMSE) was not possible and confusion assessment method (CAM) showed presence of delirium. Further, the symptoms progressed very quickly despite correction of underlying metabolic abnormalities and hence she had to be shifted to psychiatry inpatient for further management. Though the patient was admitted under section 89 of Mental Health Care Act (MHCA) of 2017, but in view of absence of licensing of our center as per MHCA at that time, no formal communication was sent to the mental health review board (MHRB). The case conference was conducted in the department and all the relevant suggestions were considered in further management of the patient. Dexmedetomidine infusion was utilized to obtain sedation in accordance to previous reports.[2] Written informed consent to publish this report was obtained from patient once she regained mental capacity to do so. However, we acknowledge that there is further need to build on the evidence for delirious mania that may often be overlooked in routine clinical practice. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.