Assessing the symptoms associated with excited delirium syndrome and the use of conducted energy weapons

Abstract

Excited delirium syndrome (ExDS) has been defined as the sudden death of an individual involving an acute (minutes to hours) transient disturbance in consciousness and cognition, marked by disorientation, disorganized and inconsistent thought processes, inability to distinguish reality from hallucinations, disturbances in speech, disorientation to time and place, and misidentification of individuals.1 In a majority of these deaths the individual exhibited violent behaviors, struggled with police, correction officers, or medical personnel during control and physical restraint of the person, within a matter of several minutes after the cessation of the struggle the person is observed to be in cardiopulmonary arrest and resuscitation is usually unsuccessful. Frequently an autopsy does not reveal anatomic evidence to show trauma or natural disease or toxicological findings sufficient to explain the death. Commonly, pathologists cite the symptoms of ExDS on the death certificate as contributing factors of the death.2–4 Deaths associated with ExDS were first reported in a case report in 1849 when psychiatrist Dr. Luther Bell at the McClean Asylum for the Insane in Massachusetts described the condition of 40 mentally ill patients who died from a fatal new disease.5 Common features observed in these patient’s deaths included: fever, rapid pulse, increasing confusion, loss of appetite and sleep, mania, and violent behaviors. Patients condition deteriorated over several weeks before dying. The clinical condition was referred to as Bell’s Mania or acute exhaustive mania and is considered the forerunner of the syndrome of ExDS.1,2,4,6 Other case reports described similar symptoms of Bell’s Mania and were referred to as acute delirious mania, lethal catatonia, acute psychotic furors exhaustive syndrome, and typhoma. As new antipsychotic medications emerged through the 1950s, the incidence of deaths associated with Bell’s Mania declined. By the mid-1980s a number of deaths associated with cocaine use were reported by Fishbain and Wetli and they described symptoms associated with chronic stimulant abuse as excited delirium.7 Common factors observed in these deaths included: acute drug intoxication, mental illness, agitation, hyperactivity, violence, bizarre and self-injurious behaviors, hallucinations, delusions, paranoia, and elevated body temperature.