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Mania in a Child with Scorpion Bite: Revisiting Catecholaminergic-cholinergic Theory of Mania

Year: 2026

Type: article

Abstract: Mania due to physical illness or drugs is conceptualized as secondary mania. Catecholaminergic-cholinergic imbalance theory is described for mania. A patient with scorpion envenomation treated with atropine represents such an imbalance. Reported here is a patient who developed manic symptoms in such a setting. The patient is a 14-year-old male child with a history of scorpion bite, presenting with cholinergic symptoms and respiratory failure. He was diagnosed with organophosphate poisoning (OP) as a history of scorpion bite was not available at presentation. He received atropine as per the OP protocol and, by Day 4, developed manic symptoms. He had no symptoms suggestive of delirium or anticholinergic toxicity except for mild tachycardia. He was treated with Olanzapine 5 mg, reaching remission by 1 week. The catecholaminergic-cholinergic theory posits mania to be a state of Catecholaminergic excess, mainly with a cholinergic-deficient state also contributing. This case clearly depicts such a state where envenomation induced a catecholaminergic excess state while atropinization would have induced a cholinergic-deficient state. This case re-emphasizes the Catecholaminergic-cholinergic imbalance theory of mania and calls for caution while treating scorpion envenomation with atropine.

Source: Journal of Indian Association for Child and Adolescent Mental Health

DOI: 10.1177/09731342261501671

Authors: Farhan Koolimadu, Ragul Ganesh, Aakriti Jha, Venkatesh Chandrasekaran, Shivanand Kattimani

Institution: Jawaharlal Institute of Post Graduate Medical Education and Research

Language: English

Topic: Bipolar Disorder and Treatment

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

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