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Acute Delirium

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Acute Delirium is the 1st quest in the Reign of Madness story arcIcon tooltip.pngStory arcs  are chains of quests that make up a story line.
Completing everything in a story arc often yields a nice reward.
The first three quests can be completed in any order to unlock The Lord of Eyes.
Acute Delirium • The Sane Asylum • The Lord of Stone • The Lord of Eyes

A scepter was once created by the Lord of Eyes himself - the Daelkyr Price of Madness, Belashyrra. Who knows what power it holds?

Reign of Madness adpack icon.jpg
DDO Point icon.png Requires access to adventure pack: Reign of Madness
Acute Delirium
Heroic level: 17
Epic level: None
Duration: Long
Heroic XP:  ♣3,485Solo/Casual ♦6,036Normal ♥6,265Hard ♠6,493Elite
Epic XP: N/A
Takes place in: The Sleeping Spell Inn
Bestowed by: Rorry Malcanus
NPC contact: Rorry Malcanus
Quest acquired in: The Twelve
Patron: The Twelve
Base favor: 7
Purchase: Reign of Madness or VIP
Extreme Challenge: No
M acute delirium.png
Loading screen


Rorry Malcanus told you that he left the Scepter of Belashyrra inside the Sleeping Spell Inn after accidentally opening a portal to Xoriat.

Enter the Inn and retrieve the Scepter. The Inn is in the Twelve Enclave.

Spoiler Warning: Spoiler material below this point!


  • Retrieve Belashyrra's Sceptre
  • Assemble an airship to fly to Xoriat:
    • 12 Beds
    • 6 Bookshelves
  • Use the Office ladder to gather aboard the airship
  • Gather inside the giant beholder
  • Flush the mimic out of hiding
  • Force the beholder to vomit
  • Use Belashyrra's Sceptre to open a portal back to Eberron
  • Gather back on Eberron
  • Equip Belashyrra's Sceptre and use it to close the portal
  • Close the portals to Xoriat and Khyber
  • (Optional) Keep the beholders from boarding the airship — Bonus (20%): Heroic( ♣697 ♦1,207 ♥1,253 ♠1,299 )
  • (Optional) Put Quixxellops out of his misery — Bonus (20%): Heroic( ♣697 ♦1,207 ♥1,253 ♠1,299 )

What to Expect

Tips and Misc

  • You can cast haste on the beds and bookshelves to make them move faster.
    • Note the three beds in the side room of the laundry.
    • If killed, beds and bookshelves will respawn in their original location. They will be harder to kill the second time, due to their "experience in combat."
  • Enemies respawn MUCH more quickly on the Elite setting and can make soloing this quest a nightmare. The beds' and bookshelves' HP does not scale and they move very slowly even with Haste. The beds also move faster than the bookshelves and can eventually outrun them. It's recommended that you make 2 trips back and forth to assemble the ship: One convoy to bring all of the beds and a separate convoy to bring all of the bookshelves. Assign 3 to 4 people to clear the way forward while the rest of the party watches the rear.
  • Two fixes were put in with U16:
    • Beholders in the Airship portion of Acute Delirium now fall to their deaths properly if they are impaired before reaching the Airship.
    • Beholders in the Airship portion of Acute Delirium are no longer considered Extraplanar (due to being in Xoriat), and can no longer be banished.
  • Be careful when fighting the mimic, when you are in the beholder's stomach. It does more and more acid damage with each hit you do.
  • The mimic in the beholder's stomach drops keys to the other chests once it's defeated, but you can also just use Open Lock or Knock on those chests.
  • After being expelled from the beholder's stomach, use the scepter to open a portal to Eberron.
  • To "close the portal", use the scepter again in the laundry where you constructed the airship, then give the scepter to Belashyrra (dialog option).

Special notes

  • You can find the 'Lost Silver Key' under one of the beds while collecting beds for the airship.
    • If that part of the ship is completed it's no longer possible to move beds.
    • This key opens the 'Lost Chest', hidden in a secret room beneath the bar. It must be opened while still in madness mode.
    • Bug: The wall hiding the door to the secret room in reality is not removed in madness mode, so the chest is unreachable
    • The secret door can be found in madness mode, at least granting some bonus XP.
  • A chest is hidden in one of several possible locations behind a shelf in the library and can be accessed while collecting shelves.
    • If that part of the ship is completed it's no longer possible to move shelves.
  • Don't forget the "Imaginary Chest", which can be reached by jumping onto the laundry walls and accessed while in madness mode.

Bonus XP

  • Devious bonus: ≥94 or fewer monsters killed +7% Bonus.( ♣244 ♦423 ♥439 ♠455 )
  • Observance bonus: 1 or more secret door discovered +8% Bonus.( ♣279 ♦483 ♥501 ♠519 )
Notes: The ransack and conquest limits are reset on entering the beholder's stomach. So the seemingly acquired bonuses are vaporized. Even over 450 kills are not sufficient for aggression bonus.


  • Chests: Up to 6, 8 or 10 (depending on difficulty)
    • 1 after opening portal to Xoriat
    • 1 underwater near the shrines, reached by jumping onto the walls in laundry room. (accessible in Madness mode only).
    • 1 behind bookshelves after they are removed (must be looted before completing airship, as shelves reappear afterwards)
    • 1 if you successfully prevent the beholders from boarding the airship.
    • Inside the Beholder's stomach, one lootable chest appears per difficulty level (1 for normal, 2 for hard, 3 for elite).
    • After the final fight, one chest appears per difficulty level (1 for normal, 2 for hard, 3 for elite).
  • Collectables: 10
    • Three Bookshelves in the library.
    • Fungus in the laundry.
    • Bookshelf in a side room near the laundry.
    • Adventurer's Pack in one of the bedrooms.
    • Cabinet in another bedroom.
    • Cabinet in the room with the mirror.
    • Mold and Fungus in the beholder's stomach.

NPC end rewards

Standard. Contains potions more frequently than other quests rewards.

Named Chest Drop

Last Edited Item Type Enhancements ML Bind Quests
  • Update 61.2
  • 7 months and 25 days
  • Bladedge
Lenses of Opportunity
Lenses of Opportunity.png
Goggles  15 Bound to Account on AcquireIcon tooltip.pngBound to Account on Acquire: This item is Bound to Account on Acquire Acute Delirium, The Lost Chest
Watcher's Blade
Item Description Watchers Blade.png
Long Sword  16 Bound to Account on AcquireIcon tooltip.pngBound to Account on Acquire: This item is Bound to Account on Acquire Acute Delirium, End chest
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Name ( picture ) CR Type Race
Armored Beholder( view
Armored Beholder.png
 • edit )
 ♠26Elite Aberration Beholder
Beholder Fleshmender( view
Beholder Fleshmender.png
 • edit )
 ♠25Elite Aberration Beholder
Beholder Priest( view
Beholder Priest.png
 • edit )
Aberration Beholder
Chaos Beholder( view
Chaos Beholder.png
 • edit )
 ♦16Normal ♥19Hard ♠23Elite Aberration Beholder
Chester( view
 • edit )
 ♦19Normal ♠29Elite Aberration Mimic
Deranged Follower( view
Deranged Follower.jpg
 • edit )
 ♦13Normal ♠18Elite Humanoid Human
Evil Eye( view
Evil Eye.png
 • edit )
 ♦12Normal ♠17Elite Aberration Evil Eye
Eye Horror( view
Eye Horror.png
 • edit )
 ♠21Elite Aberration Eye Horror
Frost Beholder( view
Frost Beholder.png
 • edit )
 ♥18Hard ♠21Elite Aberration Beholder
Ganglia( view
 • edit )
 ♠25Elite Aberration Beholder
Greater Evil Eye( view
Greater Evil Eye.png
 • edit )
 ♥17Hard ♠21Elite Aberration Evil Eye
Greater Thaarak Hound( view
Greater Thaarak Hound.png
 • edit )
 ♦15Normal ♥18Hard ♠21Elite Evil Outsider Hellhound
Haxxorrax( view
 • edit )
 ♦19Normal ♠29Elite Aberration Mind Flayer
Mind Flayer Mage( view
Mind Flayer Mage.png
 • edit )
 ♦16Normal ♥19Hard ♠23Elite Aberration Mind Flayer
Quixxellops( view
 • edit )
 ♦20Normal ♠30Elite Aberration Beholder
Taken( view
 • edit )
 ♦13Normal ♥15Hard ♠18Elite Aberration Taken
Xorian Render( view
Xorian Render.jpg
 • edit )
 ♦15Normal ♥18Hard ♠21Elite Evil Outsider Demon
Young Beholder( view
Young Beholder.jpg
 • edit )
 ♦12Normal ♥14Hard ♠17Elite Aberration Beholder

Skill DCs