How frequently cases occur is unknown. Males are affected more often than females. Those who die from the condition are typically male with an average age of 36. Often law enforcement has used tasers or physical measures in these cases. A similar condition was described in the 1800s and was referred to as "Bell's mania". The first use of the term "excited delirium" was in a 1985 Journal of Forensic Sciences article, co-authored by coroner, Charles V. Wetli, entitled "Cocaine-induced psychosis and sudden death in recreational cocaine users". The JFS article reported that in "five of the seven" cases they studied, deaths occurred while in police custody.
Inappropriately clothed e.g. having removed garments
Cause
Excited delirium occurs most commonly in males with a history of serious mental illness or acute or chronic drug abuse, particularly stimulant drugs such as cocaine and MDPV. Alcohol withdrawal or head trauma may also contribute to the condition. Physical struggle, especially if prolonged, greatly exacerbates many of the harmful symptoms such as metabolic acidosis, hyperthermia, catecholamine surge, and tachycardia. A majority of fatal cases involved men in a law enforcement or restraint situation. People with excited delirium commonly have acute drug intoxication, generally involving PCP, methylenedioxypyrovalerone, cocaine, or methamphetamine. Other drugs that may contribute to death are antipsychotics. The cause is often related to long-term drug use or mental illness. Commonly involved drugs include cocaine, methamphetamine, or certain substituted cathinones. In those with mental illness, rapidly stopping medications such as antipsychotics may trigger the condition.
In 1849 a similar condition was described by Luther Bell as "Bell's mania". It was first described under the name "excited delirium" in 1985 as a condition relating to acute cocaine intoxication.
Controversy related to policing techniques
The condition is not recognized by the American Psychiatric Association, American Medical Association or the World Health Organization. Critics of excited delirium have stated that the condition is primarily attributed to deaths while in the custody of law enforcement and is disproportionately applied to black and Hispanic victims. Eric Balaban of the American Civil Liberties Union argued in 2007 that the diagnosis served "as a means of white-washing what may be excessive use of force and inappropriate use of control techniques by officers during an arrest."
Taser use
Some civil-rights groups argue that excited delirium diagnoses are being used to absolve law enforcement of guilt in cases where alleged excessive force may have contributed to patient deaths. In 2003, the NAACP argued that excited delirium is used to explain the deaths of minorities more often than whites. In Canada, the 2007 case of Robert Dziekanski received national attention and placed a spotlight on the use of tasers in police actions and the diagnosis of excited delirium. Police psychologist Mike Webster testified at a British Columbia inquiry into taser deaths that police have been "brainwashed" by Taser International to justify "ridiculously inappropriate" use of the electric weapon. He called excited delirium a "dubious disorder" used by Taser International in its training of police. In a 2008 report, the Royal Canadian Mounted Police argued that excited delirium should not be included in the operational manual for the Royal Canadian Mounted Police without formal approval after consultation with a mental-health-policy advisory body. 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.
