Acute excited states and sudden death

Much journalism, little evidence

Excited delirium is a state of mental and physiological arousal, agitation, hyperpyrexia with epiphora, and hostility. Observers typically emphasise the extreme sweating, bizarre behaviour and speech, and the subject's extraordinary strength and endurance when struggling, apparently without fatigue. Such states are commonly associated with high blood concentrations of cocaine or other stimulants, though some cases arise in those with histories of schizophrenia or mania and no evidence of intoxication.1 The same syndrome was, however, described under various names long before drug abuse was prevalent, and was recognised for its high mortality.2 Such deaths, often in police custody or other highly charged situations, commonly give rise to high profile coroner's hearings and inquiries.3

In the era before neuroleptics death in such agitated states was attributed to exhaustion, though neuroleptic …