Excited delirium is a controversial proposed condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behaviour, insensitivity to pain, elevated body temperature, and superhuman strength.^[1][2] Excited delirium is sometimes called excited delirium syndrome if it results in sudden death (usually via cardiac or respiratory arrest), an outcome that is sometimes associated with the use of physical control measures, including police restraint.^[1][2] All^[3] or nearly all^[4] of reported cases of excited delirium involve people who are in police custody^[3] or are fighting with the police.^[4]

Signs and symptoms[edit]

The signs and symptoms for excited delirium may include:^{[2][5][6][7][8]}

• Paranoia
• Disorientation
• Hyper-aggression
• Tachycardia
• Hallucination
• Diaphoresis
• Incoherent speech or shouting
• Seemingly superhuman strength or endurance (typically while trying to resist restraint)
• Hyperthermia (overheating)/profuse sweating (even in cold weather)
• Inappropriately clothed e.g. having removed garments

Mechanisms[edit]

The pathophysiology of excited delirium has been unclear,^[6] but likely involves multiple factors.^[9] These may include positional asphyxia, hyperthermia, drug toxicity, and/or catecholamine-induced fatal cardiac arrhythmias.^[9]

Diagnosis[edit]

Other medical conditions that can resemble excited delirium are panic attack, hyperthermia, diabetes, head injury, delirium tremens, and hyperthyroidism.^[10]

Epidemiology[edit]

Excited delirium arises most commonly in male subjects with a history of serious mental illness and/or acute or chronic drug abuse, particularly stimulant drugs such as cocaine and MDPV.^[1][11] Alcohol withdrawal or head trauma may also contribute to the condition.^[5] A substantial majority of fatal case reports involved men. Excited delirium patients commonly have acute drug intoxication, generally psychostimulants such as cocaine, PCP, MDPV, and methamphetamine.^[2]

History[edit]

In 1849 a similar condition was described by Luther Bell as "Bell's mania".^[12]

It was first described under the name "excited delirium" in 1985 as a condition relating to acute cocaine intoxication.^[5][13]

Controversy[edit]

Lack of classification in DSM[edit]

Excited delirium is not found in the current version of the Diagnostic and Statistical Manual of Mental Disorders. Eric Balaban of the American Civil Liberties Union argued in 2007 that excited delirium was not recognized by the American Medical Association or the American Psychological Association and that the diagnosis served "as a means of white-washing what may be excessive use of force and inappropriate use of control techniques by officers during an arrest."^[4] Melissa Smith of the American Medical Association stated in 2007 that the organization had "no official policy" on the condition.^[14]

However the term "excited delirium" has been accepted by the National Association of Medical Examiners and the American College of Emergency Physicians, who argued in a 2009 white paper that "excited delirium" may be described by several codes within the ICD-9.^[1]

TASER use[edit]

Some civil-rights groups argue that excited delirium diagnoses are being used to absolve law enforcement of guilt in cases where alleged excessive force may have contributed to patient deaths.^[15][16][17] In 2003, the NAACP argued that excited delirium is used to explain the deaths of minorities more often than whites.^[17]

In Canada, the 2007 case of Robert Dziekanski received national attention and placed a spotlight on the use of tasers in police actions and the diagnosis of excited delirium. Police psychologist Mike Webster testified at a British Columbia inquiry into taser deaths that police have been "brainwashed" by Taser International to justify "ridiculously inappropriate" use of the electronic weapon. He called excited delirium a "dubious disorder" used by Taser International in its training of police.^[18] In a 2008 report entitled An Independent Review of the Adoption and Use of Conducted Energy Weapons by the Royal Canadian Mounted Police, the authors argued that excited delirium should not be included in the operational manual for the Royal Canadian Mounted Police without formal approval after consultation with a mental-health-policy advisory body.^[19]

A 2010 systematic review published in the Journal of Forensic and Legal Medicine argued that the symptoms associated with excited delirium likely posed a far greater medical risk than the use of tasers, and that it seems unlikely that taser use significantly exacerbates the symptoms of excited delirium.^[20]

See also[edit]

• Electroshock weapon controversy
• Positional asphyxia
• Sudden unexpected nocturnal death syndrome
• Delirium tremens
• Stimulant psychosis

References[edit]

External links[edit]

• [1] Video of an 'excited delirium' incident- police contact, suspect/patient restraint, CPR, and paramedic arrival at incident
• Is 'excited delirium' at the root of many Taser deaths? CBC News report by Armina Ligaya (2007).
• Taser firms picked up coroner's lecture tab The Globe & Mail (2007).
• Symposium aims to define 'excited delirium' The Globe & Mail (2007).
• Filings with S.E.C. & class actions for allegedly failing to disclose and misrepresention on safety.
• Taser manufacturer's view
• Excited Delirium Medical research review at the Canadian Police Research Centre
• Excited Delirium": A Two-Fold Problem S. Marshall Isaacs, M.D., San Francisco Department of Health, Paramedic Division, San Francisco, California
• Di Maio, Vincent J. M.; Theresa G. DiMaio; Di Maio, Theresa; Vincent J. M. Di Maio (2006). Excited delirium syndrome: cause of death and prevention. Boca Raton, FL: CRC/Taylor & Francis. ISBN 0-8493-1611-1. 
• [2] Bell LV (1849) On a form of disease resembling some advanced stages of mania and fever. Am. J. Insanity 6:97-127.
• The Institute For Prevention of In-Custody Deaths IPICD, Inc. is the global leader for training in excited delirium, agitated chaotic events, arrest-related deaths, and forensic investigations.
• http://www.palmbeachpost.com/news/crime/victim-in-ghoulish-flesh-eating-attack-on-the-2381017.html