There are achievements for being the duke of Dementia as well as the duke of Mania. I beat the game as the duke of Mania. Is there a way to become the duke of Dementia (and get the achievement) without starting a new game?
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I do not believe so, if there is it would be a glich and so could possibly wreck your game, but if there is one it would be on the UESP wiki, try checking there
What you can do is save your game when you have to make the choice between Duke of Mania or Dementia, choose one option then reload the game and choose the other, this should get you both achievements.
Save before choosing then pick one. Then reload after achievement and pick the other. If you have no save file before that then no. You have to restart.
For more questions for The Elder Scrolls IV: Shivering Isles check out the question page where you can search or ask your own question.
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