Excited delirium

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Excited delirium is a contoversial proposed condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, 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]

Signs and symptoms[edit]

The signs and symptoms for excited delirium may include:[2][3][4][5][6]

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


The pathophysiology of excited delirium has been unclear,[4] but likely involves multiple factors.[7] These may include positional asphyxia, hyperthermia, drug toxicity, and/or catecholamine-induced fatal cardiac arrhythmias.[7]


Other medical conditions that can resemble excited delirium are panic attack, hyperthermia, diabetes, head injury, delirium tremens, and hyperthyroidism.[8]


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.[1][9] Alcohol withdrawal or head trauma may also contribute to the condition.[3] A substantial majority of fatal case reports involved men. Excited delirium patients commonly have acute drug intoxication, generally psychostimulants such as cocaine, PCP and methamphetamine.[2]


In 1849 a similar condition was described by Luther Bell as "Bell's mania".[10]

It was first described under the name "excited delirium" in 1985 as a condition relating to acute cocaine intoxication.[3][11]


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."[12] Melissa Smith of the American Medical Association stated in 2007 that the organization had "no official policy" on the condition.[13]

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.[14][15][16] In 2003, the NAACP argued that excited delirium is used to explain the deaths of minorities more often than whites.[16]

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.[17] 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.[18]

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.[19]

See also[edit]


  1. ^ a b c d "White Paper Report on Excited Delirium Syndrome", ACEP Excited Delirium Task Force, American College of Emergency Physicians, September 10, 2009[dead link]
  2. ^ a b c d Grant JR, Southall PE, Mealey J, Scott SR, Fowler DR (March 2009). "Excited delirium deaths in custody: past and present". Am J Forensic Med Pathol 30 (1): 1–5. doi:10.1097/PAF.0b013e31818738a0. PMID 19237843. [dead link]
  3. ^ a b c Samuel E, Williams RB, Ferrell RB (2009). rticle_id=2807 "Excited delirium: Consideration of selected medical and psychiatric issues". Neuropsychiatr Dis Treat 5: 61–6. doi:10.2147/ndt.s2883. PMC 2695211. PMID 19557101. 
  4. ^ a b Lisa Hoffman (November 2009). "ACEP Recognizes Excited Delirium as Unique Syndrome". Emergency Medicine News 31 (11): 4. doi:10.1097/01.EEM.0000340950.69012.8d. [dead link]
  5. ^ Alan W. Benner, Excited Delirium, 1996
  6. ^ "Excited Delirium.org: For Law Enforcement". University of Miami. Retrieved 2011-07-01. 
  7. ^ a b Otahbachi M, Cevik C, Bagdure S, Nugent K (June 2010). "Excited delirium, restraints, and unexpected death: a review of pathogenesis". Am J Forensic Med Pathol 31 (2): 107–12. doi:10.1097/PAF.0b013e3181d76cdd. PMID 20190633. [dead link]
  8. ^ "What other medical emergencies can look like excited delirium?". PoliceOne.com. October 2006. Retrieved 2007-03-26. 
  9. ^ Ruth SoRelle (October 2010). "ExDS Protocol Puts Clout in EMS Hands". Emergency Medicine News 32 (10): 1, 32. doi:10.1097/01.EEM.0000389817.48608.e4. 
  10. ^ Kraines. "Bell's Mania". The American Journal of Psychiatry. 
  11. ^ Wetli CV, Fishbain DA (July 1985). "Cocaine-induced psychosis and sudden death in recreational cocaine users". J. Forensic Sci. 30 (3): 873–80. PMID 4031813. 
  12. ^ "Death by Excited Delirium: Diagnosis or Coverup?". NPR. Retrieved 2007-02-26. You may not have heard of it, but police departments and medical examiners are using a new term to explain why some people suddenly die in police custody. It's a controversial diagnosis called excited delirium. But the question for many civil liberties groups is, does it really exist? 
  13. ^ "Excited Delirium: Police Brutality vs. Sheer Insanity". ABC News. March 2, 2007. Retrieved 2007-03-13. Police and defense attorneys are squaring off over a medical condition so rare and controversial it can't be found in any medical dictionary — excited delirium. Victims share a host of symptoms and similarities. They tend to be overweight males, high on drugs, and display extremely erratic and violent behavior. But victims also share something else in common. The disorder seems to manifest itself when people are under stress, particularly when in police custody, and is often diagnosed only after the victims die. 
  14. ^ Truscott A (March 2008). "A knee in the neck of excited delirium". CMAJ 178 (6): 669–70. doi:10.1503/cmaj.080210. PMC 2263095. PMID 18332375. 
  15. ^ Paquette M (2003). Paquette, Mary, ed. "Excited delirium: does it exist?". Perspect Psychiatr Care 39 (3): 93–4. doi:10.1111/j.1744-6163.2003.00093.x. PMID 14606228. 
  16. ^ a b "'Excited delirium' as a cause of death", Daniel Costello, Los Angeles Times, April 21, 2003
  17. ^ Hall, Neil (2008-05-14). "Police are 'brainwashed' by Taser maker; Psychologist blames instructions". Vancouver Sun (Canwest). pp. A1. Retrieved 2008-08-30. 
  18. ^ "An Independent Review of the Adoption and Use of Conducted Energy Weapons by the Royal Canadian Mounted Police", John Kiedrowski, Royal Canadian Mounted Police, June 5, 2008
  19. ^ Jauchem JR (January 2010). "Deaths in custody: are some due to electronic control devices (including TASER devices) or excited delirium?". J Forensic Leg Med 17 (1): 1–7. doi:10.1016/j.jflm.2008.05.011. PMID 20083043. 

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