Excited Delirium Deaths in Custody

Abstract

First identified in institutionalized psychiatric populations, chronic excited delirium syndrome was not uncommon in the first half of the 20th century. After a temporal pause, excited delirium re-emerged in the 1980s, in an acute form. Generally occurring in victims without organic mental disease, acute excited delirium is associated with stimulant abuse. This exploratory research examines the evolution of excited delirium deaths in custody to determine if medical examiner cases in Maryland reflect the historical and clinical patterns identified in the existing literature. All deaths occurring from 1939 to 2005, under the purview of the Office of the Chief Medical Examiner, were reviewed. Sixty-two custodial deaths were subsequently identified, all of which documented excited delirium as a cause of death or presented with characteristics associated with excited delirium (eg, endogenous mental disease, drug intoxication, violent behavior, paranoia, or the use of physical restraints). Consistent with extant literature, acute onset excited delirium was first identified in Maryland during the 1980s. These cases generally included violent behavior, drug intoxication, and the use of restraints. In contrast, chronic forms of excited delirium were not clearly identified. This divergent finding may be an artifact of case documentation, case inclusion criteria and/or medico-legal protocol, specific to Maryland.

Brain biomarkers for identifying excited delirium as a cause of sudden death

“…TASER 1 ) are often cited [3][4][5]. However, case reviews demonstrate that the individual is medically unstable and in a rapidly declining state that has a high risk of mortality even with medical intervention or in the absence of restraint stress or CED deployment [5,6].…”

Pathophysiologic changes due to TASER® devices versus excited delirium: Potential relevance to deaths-in-custody?

“…Grant et al 152 noted, "relevant data on the length of time an individual was in custody before death occurred were not consistently available." The length of time from ECD applications until death has varied from minutes to days.…”

An analysis and report of custodial deaths in Nebraska, USA: Part II

“…Cases of positional and postural asphyxia and excited delirium in the setting of restraints are established in the literature. 4,11,12 Sudden and unexplained death has been shown to occur in the setting of altered behavior, restraints, and stimulants. 13 This case resulted from restraints in the setting of a 'spit mask,' made of fabric.…”