Excited Delirium
What is Excited Delirium ?
Typically, a person suffering from excited delirium will display signs of severe mental disturbance, and may act violently and aggressively.
If a person appears to be delirious, the security guard should avoid agitating or exciting them.
Excited delirium can be caused by a variety of factors (or a combination of them), such as:***
- Drug use
- Mental illness
- Brain injuries or tumors
- Heart disease
- High blood pressure
- low blood sugar
- Respiratory problems
- Fever
In Depth Information (Reading Material)
What is Excited Delirium Syndrome (ExDS)?
Excited Delirium is a brain disorder.
This disorder is usually drug-related (cocaine or crack, PCP orœangel dust, methamphetamine, amphetamine), but can occur in non-drug users as well.
The presentation of excited delirium occurs with a sudden onset, with symptoms of bizarre and/or aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia. Hyperthermia is a harbinger of death in these cases.
Neurochemical systems in the brain are abnormal in this disorder. At the molecular level, excited delirium is characterized by dysregulated dopamine transporters (hyperdopaminergic state), elevated heat shock proteins (hyperthermia), and immediate early gene activation as a marker of paranoid aggression (c-fos protein). These molecular changes serve as biomarkers of the disorder.
While many factors are associated with sudden death in individuals requiring restraint for excited delirium, these individuals develop a disturbance in thought, behavior and mood, and become agitated and violent. This abnormal behavioral state is due to CNS mechanisms which are the cause of lethality. The brain controls the heart and respiration. Abnormal brain activity leads to the psychosis and sudden death.
History of Excited Delirium
While excited delirium is best characterized in cocaine users, medical examiners and forensic scientists have noted a similarity in psychiatric presentation between sudden unexplained deaths in custody and psychiatric states associated with or without drug abuse.
This seminal work was first described by Dr. Charles Wetli and his collaborator David Fishbain in the mid 1980s, when the crack cocaine epidemic first hit the streets of Miami, Florida. But this disorder was known more than a decade earlier.
In 1849, Dr. Luther Bell first described a disease resembling some advanced stage of mania and fever, distinguished as an overlooked and often unrecorded malady .
This exhaustive mania was described in 40 cases by Dr. Bell where exhaustion due to mental excitement caused three quarters of these patients to die.
Similarly, a condition called neuroleptic malignant syndrome (NMS) was described in the 1960s as a potentially fatal complication of antipsychotic drugs. This highly lethal disorder is seen in patients taking dopamine (DA) antagonists or following abrupt withdrawal from DAergic agonists.
In their seminal 1985 paper, Wetli and Fishbain reported excited delirium in a cocaine body packer, and within the next few years, the syndrome was recognized in cocaine abusers as well. NMS is usually associated with muscle rigidity, while the cocaine variant of the syndrome presents with brief onset of rigidity immediately prior to respiratory collapse. In 1988, Kosten and Kleber proposed that cocaine-induced excited delirium was a variant of NMS. Alternatively, NMS may be an attenuated version of acute exhaustive mania/excited delirium. There is no doubt that these three disorders represent a common brain disease that likely has a genetic risk for certain individuals.
