Global InformationExcited delirium information
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]
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 of sedative drugs during an arrest following 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.[10] Ketamine can cause respiratory arrest, and in many cases there is no evidence of a medical condition that would justify its use.[3][11] The term excited delirium is sometimes used interchangeably with acute behavioural disturbance,[12]: 1 a symptom of a number of conditions which is also responded to with involuntary injection with benzodiazepines, antipsychotics, or ketamine.[13]: 624 [14]: 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".[15] 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".[16] 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.[17]
- ^ Obasogie OK (2021). "Excited Delirium and Police Use of Force". Virginia Law Review. 107 (8): 1545–1620. JSTOR 27135603.
- ^ 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.
- ^ a b c Cite error: The named reference
APAwas invoked but never defined (see the help page). - ^ 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.
- ^ "AAEM Excited Delirium Statement" (PDF). AAEM. Archived (PDF) from the original on May 3, 2022. Retrieved May 4, 2022.
- ^ "NAME Excited Delirium Statement 3/2023" (PDF). NAME. Archived (PDF) from the original on April 19, 2023. Retrieved April 13, 2023.
- ^ Cite error: The named reference
Reuterswas invoked but never defined (see the help page). - ^ 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.
- ^ "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.
- ^ 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): 62–9. doi:10.55460/7NEE-ZX24. PMID 25770800. S2CID 13148428.
- ^ 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.
- ^ "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.
- ^ Cameron P, Little M, Mitra B, Deasy C (May 23, 2019). Textbook of Adult Emergency Medicine E-Book. Elsevier Health Sciences. ISBN 978-0-7020-7625-1.
- ^ McKnight R, Geddes J (May 15, 2019). Psychiatry. Oxford University Press. ISBN 978-0-19-875400-8.
- ^ 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.
- ^ 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.
- ^ Royal College of Psychiatrists (2022) College Position Statement PS02/22: ‘Acute behavioural disturbance’ and ‘excited delirium Archived January 16, 2024, at the Wayback Machine