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. 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. It is not recognized by the DSM-5 or the ICD-10.
Contents
Signs and symptoms
The signs and symptoms for excited delirium may include:
Mechanisms
The pathophysiology of excited delirium has been unclear, but likely involves multiple factors. These may include positional asphyxia, hyperthermia, drug toxicity, and/or catecholamine-induced fatal cardiac arrhythmias.
Diagnosis
Other medical conditions that can resemble excited delirium are panic attack, hyperthermia, diabetes, head injury, delirium tremens, and hyperthyroidism.
Epidemiology
Excited delirium is claimed to arise 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. Alcohol withdrawal or head trauma may also contribute to the condition. 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. Other drugs that may contribute to death are antipsychotics.
History
In 1849 a similar condition was described by Luther Bell as "Bell's mania".
It was first described under the name "excited delirium" in 1985 as a condition relating to acute cocaine intoxication.
Lack of classification in DSM and ICD
Excited delirium is not found in DSM-5 or the ICD-10 (the current versions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, respectively). 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." Melissa Smith of the American Medical Association stated in 2007 that the organization had "no official policy" on the condition.
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.
In Australia, excited delirium is not recognised by the Australasian College for Emergency Medicine, the Australian Medical Association or any other registered medical body, nor in law: in 2015, a case of a male who had been ruled to have died from excited delirium was overturned by a ruling in the Victorian Coroners Court, with the presiding coroner finding that excited delirium and excited delirium syndrome are neither appropriate nor helpful for the ascribing of a medical cause of death.
TASER use
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. In 2003, the NAACP argued that excited delirium is used to explain the deaths of minorities more often than whites.
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. 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.
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.
In 2015, Natasha McKenna was tasered four times and went into cardiac arrest and died while under police custody. The autopsy report findings said the death was accidental, with excited delirium as a contributing factor due.