Excited delirium

Last updated

Excited delirium (ExDS), also known as agitated delirium (AgDS) or hyperactive delirium syndrome with severe agitation, is a widely rejected diagnosis characterized as a potentially fatal state of extreme agitation and delirium. [1] [2] It has typically been diagnosed postmortem in young adult black males who were physically restrained by law enforcement personnel at the time of death. [3] [4]

Contents

Mainstream medicine does not recognise the label as a diagnosis: it is not listed in the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases, and is not recognized by the World Health Organization, the American Psychiatric Association, the American Medical Association, the American Academy of Emergency Medicine, [5] or the National Association of Medical Examiners. [6]

Excited delirium diagnosis has been particularly associated with taser use. A 2017 investigative report by Reuters 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. The Taser manufacturing firm Axon published numerous medical studies promoting the diagnosis along with their product. [7] [8] [9]

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," [10] citing claims of excited delirium. The drugs ketamine or midazolam (a benzodiazepine) and haloperidol (an antipsychotic) injected into a muscle have sometimes been used to sedate a person at the discretion of paramedics and sometimes at direct police request. [11] Ketamine can cause respiratory arrest, and in many cases there is no evidence of a medical condition that would justify its use. [3] [12] The term excited delirium is sometimes used interchangeably with acute behavioural disturbance, [13] : 1  a symptom of a number of conditions which is also responded to with involuntary injection with benzodiazepines, antipsychotics, or ketamine. [14] [15] : 152 

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 and trauma may have been more appropriate". [16] In the U.S., neurologists writing for the Brookings Institution called it "a misappropriation of medical terminology, used by law enforcement to legitimize police brutality and to retroactively explain certain deaths occurring in police custody". [17] The American Psychiatric Association's position is that the term "is too non-specific to meaningfully describe and convey information about a person." [3] The Royal College of Psychiatrists has deprecated use of excited delirium, recommending non-diagnostic descriptions for highly agitated states such as acute behavioral disturbance. [18]

History

Throughout the 19th and early-20th century, "excited delirium" was used to describe an emotional and agitated state related to drug overdose [19] and withdrawal [20] or poisonings, [21] similar to catatonia or Bell's mania, with some believing them to be the same condition. [22]

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 . [23] [24] 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. [25] 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, Charles Henry Williams, responsible for those deaths. [26]

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 examiners 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 (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 while in custody. [9] [27]

In 2009, the American College of Emergency Physicians (ACEP) became the first medical organization to recognize excited delirium. [28] [29] In 2017, investigative reporters from Reuters reported that three members of the ACEP that suggested the recognition of excited delirium were paid consultants for Axon, the manufacturer of Tasers. [7] 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: [3] 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". [30] [31] [32] [33] [34] 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 became the first in the United States to ban the use of excited delirium as a cause of death. [35] [32]

Controversy

Association with racism

In 2003, the NAACP argued that excited delirium is used to explain the deaths of minorities more often than whites, [36] and the American Psychiatric Association also notes that "the term excited delirium is disproportionately applied to Black men in police custody". [3] The American Civil Liberties Union 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." [37]

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. [9] [27]

Excited delirium has been described as fundamentally racist by many commentators in the media, including Jon Ronson's BBC 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. [38] [39]

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. [40]

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, [7] with diagnosis often based on a test conducted by Deborah Mash, a paid consultant to Axon. In one case reported by an investigative report done by Reuters, 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 for lab work to establish a diagnosis. [7]

A 2017 report by Reuters 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. [7]

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". [41]

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 electric weapon. He called excited delirium a "dubious disorder" used by Taser International in its training of police. [42] In a 2008 report, the Royal Canadian Mounted Police 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. [43]

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, [8] 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. [44]

According to an article in the Harvard Civil Rights–Civil Liberties Law Review , 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.'" [45]

While diagnosis is habitually of men under police restraint, medical preconditions and symptoms attributed to the syndrome are far more varied. [46] [ clarification needed ]

Males account for more documented diagnoses than females. [47] Often law enforcement has used tasers or physical measures in these cases, and death most frequently occurs after the person is forcefully restrained. [48] [49] [50] 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. [48] [51] [52] 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 [86%]) or subjected to pressure on the neck (3 [14%]). All of those who died had suddenly lapsed into tranquillity shortly after being restrained". [53]

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. [46] 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 may have contributed to patient deaths. [54] [55] [36]

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 in 2020. [56] Prosecutor Steve Schleicher refuted the defense suggestion that Floyd had "superhuman strength" during his arrest because he was suffering from the condition. [57]

Ketamine use

Ketamine or midazolam and haloperidol injected into a muscle have frequently been used, sometimes at direct police request, to sedate people alleged to be experiencing excited delirium. [11] Ketamine can cause respiratory arrest, and in many cases there is no evidence of a medical condition that would justify its use. [3] [12] Following an injection the person must be transported to a hospital. In 2018, a Minneapolis hospital published a paper which reported that 57 percent of the people who had been injected for agitation needed intubation. [58]

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. [59] There have been deaths related to use of ketamine on restrained prisoners. [60] A controversial study into ketamine use was terminated due to ethics concerns. [61] The study was also linked to Axon via Jeffrey Ho. [61]

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. [62] He went into cardiac arrest a few minutes later. In a report of the case on 60 Minutes , 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." [56] [63] [64]

Rejection by most medical associations

Excited delirium is not recognized by the World Health Organization, the American Psychiatric Association, the American Medical Association, and not listed as a medical condition in the Diagnostic and Statistical Manual of Mental Disorders [3] [37] or International Classification of Diseases. [65] Dr. Michael Baden, 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". [44] In June 2021, the Royal College of Psychiatrists in the UK released a statement that they do "not support the use of such terminology [as ExDS or AgDS], which has no empirical evidential basis" and said "the use of these terms is, in effect, racial discrimination". [66]

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 must be considered the more likely cause of the death. [67]

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 (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. [28] [68]

In 2017, investigative reporters from Reuters reported that three of the 19 members of the 2009 task force were paid consultants for Axon, the manufacturer of Tasers. [7] [a] 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: [3]

The concept of "excited delirium" (also referred to as "excited delirium syndrome" (ExDs)) has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term excited delirium is disproportionately applied to Black men in police custody. Although the American College of Emergency Physicians has explicitly recognized excited delirium as a medical condition, the criteria are unclear and to date there have been no rigorous studies validating excited delirium as a medical diagnosis.

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". [69] [70] [32] [33] [71] In a statement, the ACEP said it had "withdrawn its approval of this [the 2009] paper" and that "[t]he 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". [33]

The 2021 ACEP report was criticized by some physicians for failing to sufficiently consider racial bias, similar to the 2009 report: [27]

Absent from the 2009 and 2021 reports is a substantive discussion of the potential inequitable application of the diagnosis of ExD to Black individuals, and especially Black men while in police custody or under the care of emergency medical services (EMS) care.... In contrast with the ACEP reports, the popular press has directed increasing attention to the issue of bias and ExD. News reports critically examined the concept of ExD, including racial aspects, after the diagnosis of ExD was advanced by the legal defense team and the police to explain the deaths of George Floyd and Elijah McClain, respectively.

See also

Notes

  1. ↑ The three members of the task force that were consultants for the Taser manufacturer were Deborah Mash, Charles Wetli and Jeffrey Ho.

Related Research Articles

<span class="mw-page-title-main">Catatonia</span> Psychiatric behavioural syndrome

Catatonia is a complex syndrome, most commonly seen in people with underlying mood or psychotic disorders. People with catatonia have abnormal movement and behaviors, which vary from person to person and fluctuate in intensity within a single episode. People with catatonia appear withdrawn, meaning that they do not interact with the outside world and have difficulty processing information. They may be nearly motionless for days on end or perform repetitive purposeless movements. Two people may exhibit very different sets of behaviors and both still be diagnosed with catatonia. Treatment with benzodiazepines or ECT are most effective and lead to remission of symptoms in most cases.

<span class="mw-page-title-main">Serotonin syndrome</span> Symptoms caused by an excess of serotonin in the central nervous system

Serotonin syndrome (SS) is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. The symptoms can range from mild to severe, and are potentially fatal. Symptoms in mild cases include high blood pressure and a fast heart rate; usually without a fever. Symptoms in moderate cases include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea. In severe cases, body temperature can increase to greater than 41.1 °C (106.0 °F). Complications may include seizures and extensive muscle breakdown.

<span class="mw-page-title-main">Neuroleptic malignant syndrome</span> Medical condition

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening reaction that can occur in response to antipsychotics (neuroleptic) or other drugs that block the effects of dopamine. Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate. Complications may include muscle breakdown (rhabdomyolysis), high blood potassium, kidney failure, or seizures.

Delirium is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or multiple causes, which usually develops over the course of hours to days. As a syndrome, delirium presents with disturbances in attention, awareness, and higher-order cognition. People with delirium may experience other neuropsychiatric disturbances including changes in psychomotor activity, disrupted sleep-wake cycle, emotional disturbances, disturbances of consciousness, or, altered state of consciousness, as well as perceptual disturbances, although these features are not required for diagnosis.

<span class="mw-page-title-main">Haloperidol</span> Typical antipsychotic medication

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 psychosis, and hallucinations from alcohol withdrawal. It may be used by mouth or injection into a muscle or a vein. Haloperidol typically works within 30 to 60 minutes. A long-acting formulation may be used as an injection every four weeks for people with schizophrenia or related illnesses, who either forget or refuse to take the medication by mouth.

<span class="mw-page-title-main">Positional asphyxia</span> Inability to breathe due to body position or posture

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 blocked, or where the chest may be unable to fully expand.

<span class="mw-page-title-main">Taser</span> Electroshock weapon used by law enforcement

A TASER is a conducted energy device (CED) primarily used to incapacitate people by delivering an intense electric shock that briefly disrupts voluntary control of the muscles, allowing the person to be approached and handled without resistance. The brand-name product, sold by Axon, is a handheld device which fires two small barbed darts intended to puncture the skin and remain attached to the target until removed by the user of the device. The darts are connected to the main unit by thin wires that achieve a high dielectric strength and durability given the extremely high-voltage electric current they conduct, which can be delivered in short-duration pulses from a core of copper wire in the main unit. This enormous rush of current into the body produces effects ranging from localized pain to strong involuntary long muscle contractions, causing "neuromuscular incapacitation" (NMI), based on the mode of use and connectivity of the darts. When successfully used, the target is said to have been "tased".

<span class="mw-page-title-main">Organic brain syndrome</span> Disorder of mental function whose cause is alleged to be known as physiological

Organic brain syndrome, also known as organic brain disease, organic brain damage, organic brain disorder (OBD), organic mental syndrome, or organic mental disorder, refers to any syndrome or disorder of mental function whose cause is alleged to be known as organic (physiologic) rather than purely of the mind. These names are older and nearly obsolete general terms from psychiatry, referring to many physical disorders that cause impaired mental function. They are meant to exclude psychiatric disorders. Originally, the term was created to distinguish physical causes of mental impairment from psychiatric disorders, but during the era when this distinction was drawn, not enough was known about brain science for this cause-based classification to be more than educated guesswork labeled with misplaced certainty, which is why it has been deemphasized in current medicine. While mental or behavioural abnormalities related to the dysfunction can be permanent, treating the disease early may prevent permanent damage in addition to fully restoring mental functions. An organic cause to brain dysfunction is suspected when there is no indication of a clearly defined psychiatric or "inorganic" cause, such as a mood disorder.

<span class="mw-page-title-main">Taser safety issues</span>

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 has identified increased risk in repeated, extended, or continuous exposure to the weapon; the Police Executive Research Forum says that total exposure should not exceed 15 seconds.

<span class="mw-page-title-main">Killing of Robert Dziekański</span> Polish man killed by police at Vancouver Airport

On October 14, 2007, Robert Dziekański, a 40-year old Polish immigrant to Canada, was killed during an arrest at the Vancouver International Airport in Richmond, British Columbia (BC).

A chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate the patient. Chemical restraint is used in emergency, acute, and psychiatric settings to perform surgery or to reduce agitation, aggression or violent behaviours; it may also be used to control or punish unruly behaviours. A drug used for chemical restraint may also be referred to as a "psychopharmacologic agent", "psychotropic drug" or "therapeutic restraint" in certain legal writing.

Roberto Laudisio Curti, known as Beto Laudisio, was a 21-year-old man from São Paulo, Brazil. He died on 18 March 2012 after being pursued, tackled, tasered, sprayed with OC spray, and physically compressed under the weight of multiple police officers of the New South Wales Police Force in Sydney, Australia.

Natasha J. C. McKenna was a 37-year-old African-American woman who died in Fairfax County, Virginia while in police custody. The catalyst event, extraction from her cell and being tasered while shackled, was captured on the video of the Fairfax County jail.

<span class="mw-page-title-main">Killing of Manuel Ellis</span> Homicide of a man while being arrested

Manuel Ellis was a 33-year-old African American man who died during an arrest on March 3, 2020, in Tacoma, Washington by the Tacoma Police Department. The Pierce County Sheriff's Department initially claimed that Ellis had attacked a police car and officers, leading to the arrest. State prosecutors quoted civilian witnesses as saying that Ellis did not attack the police car or officers; they also said it was the officers who attacked Ellis after a conversation. Video of the incident showed officers repeatedly punching Ellis, physically retraining him, and using a Taser. State prosecutors stated that "Ellis was not fighting back", citing witness statements and video evidence. A police radio recording showed that Ellis said he "can’t breathe". Ellis told officers "can't breathe, sir" multiple times, according to prosecutors. Ellis was hogtied, face-down, with an officer on him, for at least six minutes, and a spit hood was placed on his head in this position, stated prosecutors. Ellis died at the scene while receiving medical aid from paramedics.

<span class="mw-page-title-main">Killing of Elijah McClain</span> 2019 homicide of American man under police custody

Elijah Jovan McClain was a 23-year-old black American man from Aurora, Colorado, who was killed as a result of being illegally injected with 500 mg of ketamine by paramedics after being forcibly detained by police officers. He went into cardiac arrest and died six days later in the hospital. He had been walking home from a convenience store. Three police officers and two paramedics were charged with his death. Both paramedics and one of the officers were convicted of negligent homicide. The other two officers were acquitted of all charges.

Acute behavioral disturbance (ABD) is an umbrella term referring to various conditions of medical emergency where a person behaves in a manner that may put themselves or others at risk. It is not a formal diagnosis. Another controversial term, the widely rejected idea of excited delirium, is sometimes used interchangeably with ABD.

<span class="mw-page-title-main">Killing of Daniel Prude</span> Death of a Black man in Rochester Police custody

On March 23, 2020, Daniel Prude, a 41-year-old African-American man, died after being physically restrained by Rochester, New York police officers. Prude had been suffering from a mental health episode after ingesting PCP and left his brother's house in a disturbed and naked state. His brother called the police, which then led to the encounter with law enforcement in the street outside of his brother's house. The officers put a spit hood over his head after he began spitting. They restrained him face-down on the street for two minutes and fifteen seconds, and he stopped breathing. Prude received CPR on the scene and later died of complications from asphyxia after being taken off life support.

Angelo Quinto was a 30-year-old Filipino-American Navy veteran who died on December 26, 2020, from complications after being knelt on the neck by a police officer three days earlier. Prior to the encounter, police were responding to a call that Quinto was suffering from a mental health crisis. On February 18, 2021, Quinto's family and their lawyer, John Burris, filed a complaint against the Antioch Police Department.

<span class="mw-page-title-main">Bell's mania</span> Medical condition

Bell's mania, also known as delirious mania, refers to an acute neurobehavioral syndrome. This is usually characterized by an expeditious onset of delirium, mania, psychosis, followed by grandiosity, emotional lability, altered consciousness, hyperthermia, and in extreme cases, death. It is sometimes misdiagnosed as excited delirium (EXD) or catatonia due to the presence of overlapping symptoms. Pathophysiology studies reveal elevated dopamine levels in the neural circuit as the underlying mechanism. Psychostimulant users as well as individuals experiencing severe manic episodes are more prone to the manifestation of this condition. Management solutions such as sedation and ketamine injections have been discussed for medical professionals and individuals with the condition. Bell's mania cases are commonly reported in countries like the United States and Canada and are commonly associated with psychostimulant use and abuse.

Charles Victor Wetli was an American forensic pathologist. He is best remembered for identifying all of the victims of the Trans World Airlines Flight 800 crash in 1996 as the Suffolk County, New York medical examiner. Though he faced considerable criticism from contemporaries for his handling of the investigation into the crash, he was later praised for his ability to identify every victim's body. According to Christine Negroni, Wetli "...should be remembered as a pioneering forensic physician who assembled an array of dentists, X-ray technicians, pathologists and tiny samples of DNA to put a name on every bit of human remains recovered."

References

  1. ↑ Obasogie OK (2021). "Excited Delirium and Police Use of Force". Virginia Law Review. 107 (8): 1545–1620. JSTOR   27135603.
  2. ↑ Ives M (October 11, 2023). "California bans 'excited delirium' as cause of death". New York Times. Archived from the original on October 17, 2023. Retrieved October 20, 2023.
  3. 1 2 3 4 5 6 7 8 Position Statement on Concerns About Use of the Term 'Excited Delirium' and Appropriate Medical Management in Out-of-Hospital Contexts (PDF) (Report). American Psychiatric Association. Archived (PDF) from the original on April 5, 2021. Retrieved May 11, 2021.
  4. ↑ Strömmer EM, Leith W, Zeegers MP, Freeman MD (2020). "The role of restraint in fatal excited delirium: a research synthesis and pooled analysis". Forensic Science, Medicine, and Pathology. 16 (4): 680–692. doi:10.1007/s12024-020-00291-8. PMC   7669776 . PMID   32827300.
  5. ↑ "AAEM Excited Delirium Statement" (PDF). AAEM. Archived (PDF) from the original on May 3, 2022. Retrieved May 4, 2022.
  6. ↑ "NAME Excited Delirium Statement 3/2023" (PDF). NAME. Archived (PDF) from the original on April 19, 2023. Retrieved April 13, 2023.
  7. 1 2 3 4 5 6 "Shock Tactics: Taser inserts itself in probes involving its stun guns". Archived from the original on May 6, 2021. Retrieved May 8, 2021.
  8. 1 2 Jouvenal J (May 6, 2015). "'Excited delirium' cited in dozens of deaths in police custody. Is it real or a cover for brutality?". Washington Post. ISSN   0190-8286. Archived from the original on September 6, 2021. Retrieved May 9, 2021.
  9. 1 2 3 "Police keep using 'excited delirium' to justify brutality. It's junk science". Washington Post. ISSN   0190-8286. Archived from the original on April 24, 2021. Retrieved May 8, 2021.
  10. ↑ https://www.cbsnews.com/news/excited-delirium-police-custody-george-floyd-60-minutes-2020-12-13/
  11. 1 2 Gerold KB, Gibbons ME, Fisette RE, Alves D (2015). "Review, clinical update, and practice guidelines for excited delirium syndrome". Journal of Special Operations Medicine. 15 (1): 62–69. doi:10.55460/7NEE-ZX24. PMID   25770800. S2CID   13148428.
  12. 1 2 Appelbaum PS (July 2022). "Excited Delirium, Ketamine, and Deaths in Police Custody". Psychiatric Services. 73 (7): 827–829. doi:10.1176/appi.ps.20220204. PMID   35538746. S2CID   248694568.
  13. ↑ "Acute behavioural disturbance (ABD): guidelines on management in police custody" (PDF). Royal College of Emergency Medicine. Archived from the original (PDF) on November 1, 2020. Retrieved May 20, 2021.
  14. ↑ Cameron P, Little M, Mitra B, Deasy C (2019). Textbook of Adult Emergency Medicine E-Book. Elsevier Health Sciences. p. 624. ISBN   978-0-7020-7625-1.
  15. ↑ McKnight R, Geddes J (2019). Psychiatry. Oxford University Press. ISBN   978-0-19-875400-8.
  16. ↑ Forensic Science RegulatorGuidance: The Use of 'Excited Delirium' as a Cause of Death (PDF) (Report). Archived (PDF) from the original on January 28, 2021. Retrieved May 9, 2021.
  17. ↑ Budhu J, O'Hare M, Saadi A (August 10, 2020). "How 'excited delirium' is misused to justify police brutality". The Brookings Institution. Archived from the original on May 10, 2021. Retrieved May 11, 2021.
  18. ↑ Royal College of Psychiatrists (2022) College Position Statement PS02/22: ‘Acute behavioural disturbance’ and ‘excited delirium Archived January 16, 2024, at the Wayback Machine
  19. ↑ McClelland HA (October 1978). "Drug-Induced Delirium". Adverse Drug Reaction Bulletin. 72 (1): 256–259. doi:10.1097/00012995-197810000-00001. S2CID   71810141.
  20. ↑ "Observations on the Use of Fluids and Lumbar Puncture in the Treatment of Delirium Tremens". Annals of Internal Medicine. 12 (12): 2006. June 1, 1939. doi:10.7326/0003-4819-12-12-2006.
  21. ↑ "Surgical Memoranda". British Medical Journal. 1 (844): 258–259. March 3, 1877. PMC   2220233 . PMID   20748463.
  22. ↑ Takeuchi A, Ahern TL, Henderson SO (February 2011). "Excited delirium". The Western Journal of Emergency Medicine. 12 (1): 77–83. PMC   3088378 . PMID   21691475.
  23. ↑ McGuinness T, Lipsedge M (July 2022). "'Excited Delirium', acute behavioural disturbance, death and diagnosis". Psychological Medicine. 52 (9): 1601–1611. doi:10.1017/S0033291722001076. PMC   9280280 . PMID   35546291.
  24. ↑ Truscott A (March 2008). "A knee in the neck of excited delirium". CMAJ. 178 (6): 669–670. doi:10.1503/cmaj.080210. PMC   2263095 . PMID   18332375.
  25. ↑ Wetli C, Fishbain D (July 1985). "Cocaine-Induced Psychosis and Sudden Death in Recreational Cocaine Users". Journal of Forensic Sciences. 30 (3): 873–880. doi:10.1520/JFS11020J. PMID   4031813.
  26. ↑ Garcia-Roberts G (July 15, 2010). "Is excited delirium killing coked-up, stun-gunned Miamians?". Miami New Times. Archived from the original on April 18, 2021. Retrieved April 18, 2021.
  27. 1 2 3 Walsh B, Agboola I, Agboola I, Coupet E, Rozel J, Wong A (January 31, 2023). "Revisiting 'Excited Delirium': Does the Diagnosis Reflect and Promote Racial Bias?". Western Journal of Emergency Medicine. 24 (2): 152–159. doi:10.5811/westjem.2022.10.56478. PMC   10047747 . PMID   36976592.
  28. 1 2 Hoffman L (October 2009). "ACEP Recognizes Excited Delirium Syndrome". Emergency Medicine News. 31: 1. doi:10.1097/01.EEM.0000361897.32051.8e.
  29. ↑ SoRelle R (October 2010). "ExDS Protocol Puts Clout in EMS Hands". Emergency Medicine News. 32 (10): 1. doi: 10.1097/01.EEM.0000389817.48608.e4 .
  30. ↑ "ACEP's Position on Hyperactive Delirium". American College of Emergency Physicians. April 14, 2023. Archived from the original on June 27, 2023. Retrieved June 27, 2023.
  31. ↑ "ACEP Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings" (PDF). American College of Emergency Physicians. June 23, 2021. Archived (PDF) from the original on June 2, 2023. Retrieved June 27, 2023.
  32. 1 2 3 Johnson CK (October 12, 2023). "A doctors group calls its 'excited delirium' paper outdated and withdraws its approval". AP News. Associated Press. Archived from the original on November 4, 2023. Retrieved November 4, 2023.
  33. 1 2 3 "ACEP Reaffirms Positions on Hyperactive Delirium". www.acep.org. October 12, 2023. Archived from the original on November 4, 2023. Retrieved November 5, 2023.
  34. ↑ 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."
  35. ↑ "California becomes first state to ban use of 'excited delirium' as cause of death". The Guardian. October 10, 2023. Archived from the original on October 10, 2023. Retrieved October 10, 2023.
  36. 1 2 Costello D (April 21, 2003). "'Excited delirium' as a cause of death". Los Angeles Times . Archived from the original on November 3, 2012.
  37. 1 2 Sullivan L. "Death by Excited Delirium: Diagnosis or Coverup?". NPR . Archived from the original on March 2, 2007. Retrieved February 26, 2007. 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?
  38. ↑ Doherty S (January 16, 2024). "'Excited Delirium': The Junk Science That Covered Up a Serial Killer". VICE. Archived from the original on February 27, 2024. Retrieved February 26, 2024.
  39. ↑ "Things Fell Apart S2. Ep 1: The Most Mysterious Deaths". BBC Sounds. January 9, 2024.
  40. ↑ Joshua Budhu, Méabh O'Hare, and Altaf Saadi Monday, How "excited delirium" is misused to justify police brutality Archived November 9, 2023, at the Wayback Machine , August 10, 2020
  41. ↑ Meyer M. "Police Call It 'Excited Delirium.' Civil Rights Groups Call It a Sham". Harvard Civil Rights-Civil Liberties Law Review. Archived from the original on May 7, 2021. Retrieved May 6, 2021.
  42. ↑ Hall N (May 14, 2008). "Police are 'brainwashed' by Taser maker; Psychologist blames instructions". Vancouver Sun . Canwest. pp. A1. Archived from the original on May 14, 2008. Retrieved August 30, 2008.
  43. ↑ Kiedrowski J (June 5, 2008). "An Independent Review of the Adoption and Use of Conducted Energy Weapons by the Royal Canadian Mounted Police". Royal Canadian Mounted Police. Archived from the original on December 31, 2009.
  44. 1 2 "Excited delirium: Rare and deadly syndrome or a condition to excuse deaths by police?". Archived from the original on May 9, 2021. Retrieved May 9, 2021.
  45. ↑ "Special Report: How Taser inserts itself into investigations involving its weapons". Reuters. August 24, 2017. Archived from the original on May 12, 2021. Retrieved May 11, 2021.
  46. 1 2 Baker D (December 2018). "Making Sense of 'Excited Delirium' in Cases of Death after Police Contact". Policing: A Journal of Policy and Practice. 12 (4): 361–371. doi:10.1093/police/pax028.
  47. ↑ Gonin P, Beysard N, Yersin B, Carron PN (May 2018). "Excited Delirium: A Systematic Review". Academic Emergency Medicine. 25 (5): 552–565. doi: 10.1111/acem.13330 . PMID   28990246.
  48. 1 2 Santo A (June 4, 2020). "An Officer Suggested George Floyd Had 'Excited Delirium.' Experts Say That's Not a Real Thing". Slate. Archived from the original on June 17, 2020. Retrieved June 17, 2020. They note, for example, that it's disproportionately cited in cases where black and Hispanic men die in custody.
  49. ↑ Goldman R (March 2, 2007). "Excited Delirium: Police Brutality vs. Sheer Insanity". ABC News . Archived from the original on December 10, 2008. Retrieved March 13, 2007. 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.
  50. ↑ Singh M (July 2, 2020). "How America's broken autopsy system can mask police violence". The Guardian . Archived from the original on July 3, 2020. Retrieved July 3, 2020.
  51. ↑ Wedell K, Kelly C. "'Excited delirium' cited as factor in many fatal police restraint cases. Some say it's bogus". USA Today. Archived from the original on June 16, 2020. Retrieved June 17, 2020. For decades critics have pointed to the fact that the term is applied almost exclusively to in-custody deaths or that otherwise involve law enforcement.
  52. ↑ Koerth M (June 8, 2020). "The Two Autopsies Of George Floyd Aren't As Different As They Seem". FiveThirtyEight. Archived from the original on June 17, 2020. Retrieved June 17, 2020. The dead people diagnosed with it tend to be young, black males who died in police custody, he said.
  53. ↑ Pollanen MS, Chiasson DA, Cairns JT, Young JG (June 16, 1998). "Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community". CMAJ. 158 (12): 1603–1607. PMC   1229410 . PMID   9645173. ProQuest   204779547.
  54. ↑ Truscott A (March 2008). "A knee in the neck of excited delirium". CMAJ. 178 (6): 669–670. doi:10.1503/cmaj.080210. PMC   2263095 . PMID   18332375.
  55. ↑ Paquette M (2003). Paquette M (ed.). "Excited delirium: does it exist?". Perspectives in Psychiatric Care. 39 (3): 93–94. doi: 10.1111/j.1744-6163.2003.00093.x . PMID   14606228.
  56. 1 2 "Police Repeatedly Cite 'Excited Delirium' In Killings, But It Has No Real Definition". NPR.org. Archived from the original on April 15, 2021. Retrieved April 15, 2021.
  57. ↑ "Explainer: Why 'excited delirium' came up at Chauvin trial?". AP News. August 21, 2021. Archived from the original on April 19, 2021. Retrieved April 20, 2021.
  58. ↑ Mannix A (June 24, 2018). "Patients sedated by ketamine were enrolled in Hennepin Healthcare study". Star Tribune. Archived from the original on May 11, 2021. Retrieved May 11, 2021.
  59. ↑ Sidner S, Jones J (September 2020). "Two strangers, with the same first name, and a terrifying story about ketamine in policing". CNN. Archived from the original on September 19, 2020. Retrieved September 28, 2020.
  60. ↑ "Excited Delirium: The controversial syndrome that can be used to protect police from misconduct charges". Archived from the original on December 19, 2020. Retrieved May 8, 2021.
  61. 1 2 "Taser, Hennepin Healthcare have a research relationship". Archived from the original on May 9, 2021. Retrieved May 8, 2021.
  62. ↑ Ortiz E (July 1, 2020). "Elijah McClain was injected with ketamine while handcuffed. Some medical experts worry about its use during police calls". NBC News. Archived from the original on July 3, 2020. Retrieved July 3, 2020.
  63. ↑ Tompkins L. "Here's What You Need to Know About Elijah McClain's Death". New York Times. Archived from the original on July 1, 2020. Retrieved May 9, 2021.
  64. ↑ "Excited Delirium: The controversial syndrome that can be used to protect police from misconduct charges". CBS 60 Minutes. December 13, 2020. Archived from the original on December 19, 2020. Retrieved May 9, 2021.
  65. ↑ Vilke GM, Payne-James JJ (2016). Current Practice in Forensic Medicine. John Wiley & Sons, Ltd. pp. 97–117. doi:10.1002/9781118456026.ch6. ISBN   9781118456026.
  66. ↑ "Statement on Acute Behavioural Disturbance (ABD)". Royal College of Psychiatrists. June 23, 2021. Archived from the original on July 9, 2021. Retrieved July 6, 2021.
  67. ↑ Strömmer EM, Leith W, Zeegers MP, Freeman MD (2020). "The role of restraint in fatal excited delirium: a research synthesis and pooled analysis". Forensic Science, Medicine, and Pathology. 16 (4): 680–692. doi:10.1007/s12024-020-00291-8. PMC   7669776 . PMID   32827300.
  68. ↑ SoRelle R (October 2010). "ExDS Protocol Puts Clout in EMS Hands". Emergency Medicine News. 32 (10): 1. doi: 10.1097/01.EEM.0000389817.48608.e4 .
  69. ↑ "ACEP's Position on Hyperactive Delirium". American College of Emergency Physicians. April 14, 2023. Archived from the original on June 27, 2023. Retrieved June 27, 2023.
  70. ↑ "ACEP Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings" (PDF). American College of Emergency Physicians. June 23, 2021. Archived (PDF) from the original on June 2, 2023. Retrieved June 27, 2023.
  71. ↑ 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."
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.