Excited Delirium
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Excited delirium (ExDS), also known as agitated delirium (AgDS) or hyperactive delirium syndrome with severe agitation, is a widely rejected
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diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...
characterized as a potentially fatal state of extreme agitation and
delirium Delirium (formerly acute confusional state, an ambiguous term that is now discouraged) is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or ...
. It has typically been diagnosed postmortem in young adult
black Black is a color that results from the absence or complete absorption of visible light. It is an achromatic color, without chroma, like white and grey. It is often used symbolically or figuratively to represent darkness.Eva Heller, ''P ...
males who were physically restrained by law enforcement personnel at the time of death, with the claim that the subject's death was merely coincidental and largely unrelated to the use of force. Mainstream medicine does not recognise the label as a diagnosis. It is not listed in the ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
'' or the
International Classification of Diseases The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnosis. The ICD is maintained by the World Health Organization (WHO), which is the dir ...
, and is not recognized by the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
, the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...
, the
American Medical Association The American Medical Association (AMA) is an American professional association and lobbying group of physicians and medical students. This medical association was founded in 1847 and is headquartered in Chicago, Illinois. Membership was 271,660 ...
, the American Academy of Emergency Medicine, or the National Association of Medical Examiners. A 2017 investigative report by
Reuters Reuters ( ) is a news agency owned by Thomson Reuters. It employs around 2,500 journalists and 600 photojournalists in about 200 locations worldwide writing in 16 languages. Reuters is one of the largest news agencies in the world. The agency ...
found that excited delirium had been listed as a factor in
autopsy An autopsy (also referred to as post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of deat ...
reports, court records or other sources in at least 276 deaths that followed taser use since 2000. The Taser manufacturing firm
Axon An axon (from Greek ἄξων ''áxōn'', axis) or nerve fiber (or nerve fibre: see American and British English spelling differences#-re, -er, spelling differences) is a long, slender cellular extensions, projection of a nerve cell, or neuron, ...
published numerous medical studies promoting the diagnosis along with their product. There have been concerns raised over the use by law enforcement and emergency medical personnel partners to inject sedative drugs, a practice nicknamed " policing by needle," citing claims of excited delirium. The drugs
ketamine Ketamine is a cyclohexanone-derived general anesthetic and NMDA receptor antagonist with analgesic and hallucinogenic properties, used medically for anesthesia, depression, and pain management. Ketamine exists as its S- (esketamine) a ...
or
midazolam Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia, premedication before surgical anesthesia, and procedural sedation, and to treat psychomotor agitation, severe agitation. It induces ...
(a
benzodiazepine Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant, depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed t ...
) and
haloperidol Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychos ...
(an
antipsychotic Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), p ...
) injected into a muscle have sometimes been used to sedate a person at the discretion of
paramedics A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), m ...
and sometimes at direct police request. Ketamine can cause
respiratory arrest Respiratory arrest is a serious medical condition caused by apnea or respiratory dysfunction severe enough that it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long period ...
, and in many cases there is no evidence of a medical condition that would justify its use. The term excited delirium is sometimes used interchangeably with acute behavioural disturbance, a symptom of a number of conditions which is also responded to with involuntary injection with benzodiazepines,
antipsychotics Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizo ...
, or ketamine. A 2020 investigation by the United Kingdom Forensic Science Regulator found that the diagnosis should not have been used since it "has been applied in some cases where other important pathological mechanisms, such as
positional asphyxia Positional asphyxia, also known as postural asphyxia, is a form of asphyxia which occurs when someone's position prevents the person from breathing adequately. People may die from positional asphyxia accidentally, when the mouth and nose are ...
and trauma may have been more appropriate". In the U.S., neurologists writing for the
Brookings Institution The Brookings Institution, often stylized as Brookings, is an American think tank that conducts research and education in the social sciences, primarily in economics (and tax policy), metropolitan policy, governance, foreign policy, global econo ...
called it "a misappropriation of medical terminology, used by law enforcement to legitimize
police brutality Police brutality is the excessive and unwarranted use of force by law enforcement against an individual or Public order policing, a group. It is an extreme form of police misconduct and is a civil rights violation. Police brutality includes, b ...
and to retroactively explain certain deaths occurring in police custody". The American Psychiatric Association's position is that the term "is too non-specific to meaningfully describe and convey information about a person." The
Royal College of Psychiatrists The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom, and is responsible for representing psychiatrists, for psychiatric research and for providing public information about mental healt ...
has deprecated use of excited delirium, recommending non-diagnostic descriptions for highly agitated states such as acute behavioral disturbance.


History

Throughout the 19th and early-20th century, "excited delirium" was used to describe an emotional and agitated state related to drug overdose and withdrawal or poisonings, similar to
catatonia Catatonia is a complex syndrome most commonly seen in people with underlying mood disorders, such as major depressive disorder, or psychotic disorders, such as schizophrenia. People with catatonia exhibit abnormal movement and behaviors, wh ...
or Bell's mania, with some believing them to be the same condition. In 1985, an article titled "Cocaine-induced psychosis and sudden death in recreational cocaine users", co-authored by Dade County deputy chief medical examiner Charles Victor Wetli was published in the ''
Journal of Forensic Sciences The ''Journal of Forensic Sciences'' (''JFS'') is a bimonthly peer-reviewed scientific journal is the official publication of the American Academy of Forensic Sciences, published by Wiley-Blackwell. It covers all aspects of forensic science. The m ...
''. The article describes a state of "excited delirium" in cocaine users leading to respiratory collapse and death, despite the people having blood concentrations of cocaine ten times lower than those seen in fatal overdoses. In five of the seven cases presented in the article, the deaths occurred while in police custody. In 1988, Wetli claimed that a series of nineteen women, all Black prostitutes, had died of excited delirium due to "sexual excitement" while under the influence of cocaine. Police later announced they had found a
serial killer A serial killer (also called a serial murderer) is a person who murders three or more people,An offender can be anyone: * * * * * (This source only requires two people) with the killings taking place over a significant period of time in separat ...
, Charles Henry Williams, responsible for those deaths. By the 1990s, the term "excited delirium" (ExDS) began to be used as a diagnosis to explain deaths in police custody especially during or after restraint, particularly in Florida. Despite the increasing usage of "excited delirium" in the 1990s by some
medical examiner The medical examiner is an appointed official in some American jurisdictions who is trained in pathology and investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdicti ...
s and police, mainstream medical associations refused to recognize the legitimacy of the purported syndrome, and it was never listed in the ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
'' (DSM). In the early 2000s, medical commentators noted that excited delirium was used disproportionately against African Americans, and alleged that police often used it to cover up deaths resulting from
police brutality Police brutality is the excessive and unwarranted use of force by law enforcement against an individual or Public order policing, a group. It is an extreme form of police misconduct and is a civil rights violation. Police brutality includes, b ...
while in custody. In 2009, the
American College of Emergency Physicians The American College of Emergency Physicians (ACEP) is a professional organization of emergency medicine physicians in the United States. ACEP publishes the '' Annals of Emergency Medicine and the Journal of the American College of Emergency Physi ...
(ACEP) became the first medical organization to recognize excited delirium. In 2017, investigative reporters from
Reuters Reuters ( ) is a news agency owned by Thomson Reuters. It employs around 2,500 journalists and 600 photojournalists in about 200 locations worldwide writing in 16 languages. Reuters is one of the largest news agencies in the world. The agency ...
reported that three members of the ACEP that suggested the recognition of excited delirium were paid consultants for Axon, the manufacturer of Tasers. In 2020, the American Psychiatric Association expressed concern about the ACEP's adoption of excited delirium as a genuine syndrome, due to factors such as disproportionate application to African-Americans: In 2023 the ACEP withdrew its recognition of excited delirium as a valid syndrome, and defined a new syndrome, which they named "hyperactive delirium syndrome". Mainstream medical organizations continued to withhold recognition of either the old syndrome or new syndrome, due to the absence of scientific rigor or evidence. In 2023, the state of
California California () is a U.S. state, state in the Western United States that lies on the West Coast of the United States, Pacific Coast. It borders Oregon to the north, Nevada and Arizona to the east, and shares Mexico–United States border, an ...
became the first in the
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
to ban the use of excited delirium as a cause of death.


Controversy


Association with racism

In 2003, the
NAACP The National Association for the Advancement of Colored People (NAACP) is an American civil rights organization formed in 1909 as an interracial endeavor to advance justice for African Americans by a group including W. E. B. Du&nbs ...
argued that excited delirium is used to explain the deaths of
minorities The term "minority group" has different meanings, depending on the context. According to common usage, it can be defined simply as a group in society with the least number of individuals, or less than half of a population. Usually a minority g ...
more often than
whites White is a racial classification of people generally used for those of predominantly European ancestry. It is also a skin color specifier, although the definition can vary depending on context, nationality, ethnicity and point of view. De ...
, and the American Psychiatric Association also notes that "the term excited delirium is disproportionately applied to Black men in police custody". The
American Civil Liberties Union The American Civil Liberties Union (ACLU) is an American nonprofit civil rights organization founded in 1920. ACLU affiliates are active in all 50 states, Washington, D.C., and Puerto Rico. The budget of the ACLU in 2024 was $383 million. T ...
argued in 2007 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." Several academic commentators have noted that medical personnel and law enforcement personnel apply diagnoses of excited delirium in a manner which disproportionately disadvantages African Americans. In addition, commentators have alleged that fallacious diagnoses of excited delirium have been used to cover-up instances of
police brutality Police brutality is the excessive and unwarranted use of force by law enforcement against an individual or Public order policing, a group. It is an extreme form of police misconduct and is a civil rights violation. Police brutality includes, b ...
. Excited delirium has been described as fundamentally racist by many commentators in the media, including
Jon Ronson Jon Ronson (born 10 May 1967) is a British-American journalist, author, and filmmaker. He is known for works such as '' Them: Adventures with Extremists'' (2001), '' The Men Who Stare at Goats'' (2004), and '' The Psychopath Test'' (2011). H ...
's
BBC The British Broadcasting Corporation (BBC) is a British public service broadcaster headquartered at Broadcasting House in London, England. Originally established in 1922 as the British Broadcasting Company, it evolved into its current sta ...
podcast ''Things Fell Apart'' in 2024. The episode, titled
The Most Mysterious Deaths
, describes Wetli's initial coining of the phrase "excited delirium", as well as the later debunking of the phenomenon, and its connection to the murder of George Floyd. Before the term "excited delirium" was rejected by the ACEP in 2023, its supposed risk factors vary including "bizarre behavior generating phone calls to police", "failure to respond to police presence", and "continued struggle despite restraint". It supposedly endows individuals with "superhuman strength" and being "impervious to pain". It is disproportionately diagnosed among young Black males, and has clear undertones of racial bias.Joshua Budhu, Méabh O'Hare, and Altaf Saadi Monday
How "excited delirium" is misused to justify police brutality
, August 10, 2020


Influence of Taser manufacturer

Axon Enterprise, formerly Taser International, provides training for police on recognizing excited delirium and several prominent proponents of the diagnosis are retained by Axon, with diagnosis often based on a test conducted by Deborah Mash, a paid consultant to Axon. A 2017 report by
Reuters Reuters ( ) is a news agency owned by Thomson Reuters. It employs around 2,500 journalists and 600 photojournalists in about 200 locations worldwide writing in 16 languages. Reuters is one of the largest news agencies in the world. The agency ...
found that excited delirium had been listed as a factor in autopsy reports, court records or other sources in at least 276 deaths that followed taser use since 2000, with diagnosis often based on a test conducted by Deborah Mash. In one case, within four hours of a man dying after being tasered, Axon had provided model press releases, instructions for gathering evidence of excited delirium, and advised that samples be sent to Mash. Axon has paid thousands of dollars to proponents of the excited delirium diagnosis, including Charles Wetli who first proposed the term, who have repeatedly used "excited delirium" as a defense in liability suits and to shield police officers from criminal liability for deaths in custody. Axon has instigated litigation against some medical examiners who suggested that tasers were a factor in the death of restrained persons. Scholars have speculated that this may have a chilling effect on the reports published by some medical examiners. A survey in 2011 showed that 14% of medical examiners had altered a diagnostic finding "out of fear of litigation by the company". In
Canada Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
, 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 British Columbia is the westernmost Provinces and territories of Canada, province of Canada. Situated in the Pacific Northwest between the Pacific Ocean and the Rocky Mountains, the province has a diverse geography, with rugged landscapes that ...
inquiry into taser deaths that police have been "brainwashed" by
Taser International Axon Enterprise, Inc. (formerly TASER International) is an American company based in Scottsdale, Arizona, that develops technology and weapons products for military, law enforcement, and civilians. Its initial product and former namesake is the ...
to justify "ridiculously inappropriate" use of the electric weapon. He called excited delirium a "dubious disorder" used by Taser International in its training of police. In a 2008 report, the
Royal Canadian Mounted Police The Royal Canadian Mounted Police (RCMP; , GRC) is the Law enforcement in Canada, national police service of Canada. The RCMP is an agency of the Government of Canada; it also provides police services under contract to 11 Provinces and terri ...
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.


Association with police restraint

Amnesty International found that the syndrome was cited in 75 of the 330 deaths following police use of a taser on suspects between 2001 and 2008, and a Florida-based study found it was listed as a cause of death in over half of all deaths in police custody, though many Florida districts do not use it at all. According to an article in the ''
Harvard Civil Rights–Civil Liberties Law Review The ''Harvard Civil Rights – Civil Liberties Law Review'' is a student-run law review published by Harvard Law School. Founded in 1966, the journal is published two times per year and contains articles, essays, and book reviews concerning civil r ...
'', since 2000, over one thousand people in the United States have died shortly after being tased, with the deaths sharing several commonalities: "the deceased often were mentally ill or under the influence of drugs at the time of death, they tend to have been shocked multiple times by officers during arrest, and they often share an exceptionally rare cause of death, 'excited delirium.'" While diagnosis is habitually of men under police restraint, medical preconditions and symptoms attributed to the syndrome are far more varied. Males account for more documented diagnoses than females. Often law enforcement has used
tasers Taser (stylized in all caps) is a line of handheld conducted energy devices (CED) sold by Axon Enterprise (formerly Taser International). The device fires two small barbed darts intended to puncture the skin and remain attached to the targe ...
or physical measures in these cases, and death most frequently occurs after the person is forcefully restrained. Critics of excited delirium have stated that the condition is primarily attributed to deaths while in the custody of law enforcement and is disproportionately applied to Black and Hispanic victims. One study looking at cocaine-related deaths in the 1970s and 1980s in Florida, showed that the deaths were more likely to be diagnosed as excited delirium when involving young Black men dying in police custody and "accidental cocaine toxicity" when involving white people. A 1998 study found that "In all 21 cases of unexpected death associated with excited delirium, the deaths were associated with restraint (for violent agitation and hyperactivity), with the person either in a prone position (18 people 6% or subjected to pressure on the neck (3 4%. All of those who died had suddenly lapsed into tranquillity shortly after being restrained". The UK Independent Advisory Panel on Deaths in Custody (IAP) suggests that the syndrome should be termed "Sudden death in restraint syndrome" in order to enhance clarity. Some civil-rights groups have argued that excited delirium diagnoses are being used to absolve law enforcement of guilt in cases where alleged
excessive force Police brutality is the excessive and unwarranted use of force by law enforcement against an individual or a group. It is an extreme form of police misconduct and is a civil rights violation. Police brutality includes, but is not limited to, ...
may have contributed to patient deaths. Prominent cases include Daniel Prude, who was said to be in a state of excited delirium in 2020 when police put a hood over his head and pressed his naked body against the pavement. Prude, a Black man, lost consciousness and died. Excited delirium was also cited by the defense in '' State v. Chauvin'', a murder trial related to the
murder of George Floyd On May 25, 2020, George Floyd, a 46-year-old Black American man, was murdered in Minneapolis by Derek Chauvin, a 44-year-old White police officer. Floyd had been arrested after a store clerk reported that he made a purchase using a c ...
in 2020. Prosecutor Steve Schleicher refuted the defense suggestion that Floyd had "superhuman strength" during his arrest because he was suffering from the condition.


Ketamine use

Ketamine Ketamine is a cyclohexanone-derived general anesthetic and NMDA receptor antagonist with analgesic and hallucinogenic properties, used medically for anesthesia, depression, and pain management. Ketamine exists as its S- (esketamine) a ...
or
midazolam Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia, premedication before surgical anesthesia, and procedural sedation, and to treat psychomotor agitation, severe agitation. It induces ...
and
haloperidol Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychos ...
injected into a muscle have frequently been used, sometimes at direct police request, to sedate people alleged to be experiencing excited delirium. Ketamine can cause respiratory arrest, and in many cases there is no evidence of a medical condition that would justify its use. Following an injection the person must be transported to a hospital. In 2018, a
Minneapolis Minneapolis is a city in Hennepin County, Minnesota, United States, and its county seat. With a population of 429,954 as of the 2020 United States census, 2020 census, it is the state's List of cities in Minnesota, most populous city. Locat ...
hospital published a paper which reported that 57 percent of the people who had been injected for agitation needed
intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to supp ...
. Concern has been raised about the increasing usage of a claim of excited delirium to justify tranquilizing persons during arrest, with requests for tranquilization often being made by law enforcement rather than medical professionals. Ketamine is the most commonly used drug in these cases. There have been deaths related to use of ketamine on restrained prisoners. A controversial study into ketamine use was terminated due to ethics concerns. The study was also linked to Axon via Jeffrey Ho. In 2019, Elijah McClain, a Black man, was arrested by police officers after receiving a 911 call which reported a man walking, waving his arms and wearing a ski mask. The officers said that he was exhibiting "crazy strength" when they attempted to arrest him but all three said that their body cams had fallen off and thus there was no video of what they claimed to be a violent struggle. McClain weighed 140 pounds and was 5 feet 6 inches tall. He was handcuffed and then a choke hold was used twice, once "successfully" meaning that McClain lost consciousness. When paramedics arrived they administered enough ketamine to sedate a 220-pound man. He went into cardiac arrest a few minutes later. In a report of the case on ''
60 Minutes ''60 Minutes'' is an American television news magazine broadcast on the CBS television network. Debuting in 1968, the program was created by Don Hewitt and Bill Leonard, who distinguished it from other news programs by using a unique style o ...
'', John Dickerson interviewed the District Attorney who justified the use of ketamine, adding that since excited delirium could not be ruled out as a cause of death it would be impossible to win a homicide case because "you can't file a homicide charge without cause of death."


Rejection by most medical associations

Excited delirium is not recognized by the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
, the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...
, the
American Medical Association The American Medical Association (AMA) is an American professional association and lobbying group of physicians and medical students. This medical association was founded in 1847 and is headquartered in Chicago, Illinois. Membership was 271,660 ...
, and not listed as a medical condition in the
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a com ...
or
International Classification of Diseases The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnosis. The ICD is maintained by the World Health Organization (WHO), which is the dir ...
. Dr.
Michael Baden Michael M. Baden (born July 27, 1934) is an American physician and board-certified forensic pathologist known for his work investigating high-profile deaths and as the host of HBO's ''Autopsy''. Baden was the chief medical examiner of the Ci ...
, a specialist in investigating deaths in custody, describes excited delirium as "a boutique kind of diagnosis created, unfortunately, by many of my forensic pathology colleagues specifically for persons dying when being restrained by law enforcement". In June 2021, the
Royal College of Psychiatrists The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom, and is responsible for representing psychiatrists, for psychiatric research and for providing public information about mental healt ...
in the UK released a statement that they do "not support the use of such terminology s ExDS or AgDS which has no empirical evidential basis" and said "the use of these terms is, in effect, racial discrimination". A 2020 scientific literature review looked at reported cases of excited delirium and agitated delirium. The authors noted that most published current information has indicated that excited delirium-related deaths are due to an occult pathophysiologic process. A database of cases was created which included the use of force, drug intoxication, mental illness, demographics, and survival outcome. A review of cases revealed there was no evidence to support ExDS as a cause of death in the absence of restraint. The authors found that when death occurred in an aggressively restrained individual that fits the profile of either ExDS or AgDS, restraint-related
asphyxia Asphyxia or asphyxiation is a condition of deficient supply of oxygen to the body which arises from abnormal breathing. Asphyxia causes generalized hypoxia, which affects all the tissues and organs, some more rapidly than others. There are m ...
must be considered the more likely cause of the death.


Position of the American College of Emergency Physicians

Prior to 2009, excited delirium was only recognized by Medical Examiners, not physicians. But in 2009, a 19-person task force from
American College of Emergency Physicians The American College of Emergency Physicians (ACEP) is a professional organization of emergency medicine physicians in the United States. ACEP publishes the '' Annals of Emergency Medicine and the Journal of the American College of Emergency Physi ...
(ACEP) wrote a white paper suggesting that excited delirium should be considered as a valid syndrome, which physicians can use for diagnoses. This suggestion was adopted by the ACEP later in 2009. In 2017, investigative reporters from
Reuters Reuters ( ) is a news agency owned by Thomson Reuters. It employs around 2,500 journalists and 600 photojournalists in about 200 locations worldwide writing in 16 languages. Reuters is one of the largest news agencies in the world. The agency ...
reported that three of the 19 members of the 2009 task force were paid consultants for Axon, the manufacturer of Tasers. Axon frequently blames excited delirium for stun-gun-related deaths. In 2020, the American Psychiatric Association expressed concern about the ACEP's adoption of excited delirium as a genuine syndrome, due to factors such as disproportionate application to African-Americans: In 2021, the ACEP created a new task force to reevaluate the excited delirium syndrome. As a result, in 2023 the ACEP withdrew the 2009 white paper, which defined the syndrome, and instead endorsed a new syndrome "hyperactive delirium syndrome with severe agitation".Statement from the ACEP excerpt: ''"The American College of Emergency Physicians (ACEP) recognizes the existence of hyperactive delirium syndrome with severe agitation, a potentially life threatening clinical condition characterized by a combination of vital sign abnormalities (e.g., elevated temperature and blood pressure), pronounced agitation, altered mental status, and metabolic derangements.... ACEP does not recognize the use of the term “excited delirium” and its use in clinical settings.''" In a statement, the ACEP said it had "withdrawn its approval of this he 2009paper" and that " e term excited delirium should not be used among the wider medical and public health community, law enforcement organizations, and ACEP members acting as expert witnesses testifying in relevant civil or criminal litigation". The 2021 ACEP report was criticized by some physicians for failing to sufficiently consider racial bias, similar to the 2009 report:


See also

*
Positional asphyxia Positional asphyxia, also known as postural asphyxia, is a form of asphyxia which occurs when someone's position prevents the person from breathing adequately. People may die from positional asphyxia accidentally, when the mouth and nose are ...
*
Stimulant psychosis Stimulant psychosis is a mental disorder characterized by psychotic symptoms such as hallucinations, paranoid ideation, delusions, disorganized thinking, and grossly disorganized behaviour. It typically occurs following an overdose or several ...
*
Taser safety issues The Taser is a ''less- lethal'', not non-lethal, weapon, since the possibility of serious injury or death exists whenever the weapon is deployed. It is a brand of conducted electroshock weapon sold by Axon, formerly TASER International. Axon h ...
*
Drapetomania Drapetomania was a proposed mental illness that, in 1851, American physician Samuel A. Cartwright hypothesized as the cause of enslaved Africans fleeing captivity. This hypothesis was based on the belief that slavery was such an improvement upo ...


Notes


References

{{reflist 1985 neologisms Police brutality Medical emergencies Medical controversies in the United States Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate Psychiatry controversies Pseudoscience Taser Delirium