Excited Delirium - Pathophysiology and Symptoms

Pathophysiology and Symptoms

"Excited delirium" was first explicitly described in 1985 as a condition relating to acute cocaine intoxication.

Prior to this it was referred to as "Bell's Mania"; first described by Luther Bell in 1849.

The pathophysiology of excited delirium has been unclear, but likely involves multiple factors. These may include positional asphyxia, hyperthermia, drug toxicity, and/or catecholamine-induced fatal cardiac arrhythmias.

A substantial majority of fatal case reports involved men, most commonly African American. Excited delirium patients commonly have acute drug intoxication, generally psychostimulants such as cocaine, PCP and methamphetamine.

The signs and symptoms for excited delirium may include:

• Paranoia
• Disorientation
• Hyper-aggression
• Tachycardia
• Hallucination
• Incoherent speech or shouting
• Seemingly superhuman strength or endurance (typically while trying to resist restrain efforts)
• Hyperthermia (overheating)/profuse sweating (even in cold weather)

Other medical conditions that can resemble excited delirium are panic attack, hyperthermia, diabetes, head injury, delirium tremens, and hyperthyroidism.

A 2010 systematic review published in the Journal of Forensic and Legal Medicine argued that the symptoms associated with excited delirium likely posed a far greater medical risk than the use of tasers, and that it seems unlikely that taser use significantly exacerbates the symptoms of excited delirium.