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Excited delirium: what’s the evidence for its use in medicine?

BMJ 2021; 373 doi: (Published 05 May 2021) Cite this as: BMJ 2021;373:n1156
  1. Abi Rimmer
  1. The BMJ

It’s a controversial term that divides the medical community, but how did excited delirium enter the medical lexicon, and should it remain there? Abi Rimmer examines the evidence

Its close association with police enforcement has left the term “excited delirium” shrouded in controversy. It was recently mentioned in the trial of Derek Chauvin, the former US police officer found guilty of the murder of George Floyd,1 although it was not a key aspect of the evidence.2

What is it?

That’s a complicated question. In 2009 the American College of Emergency Physicians formally recognised excited delirium as a unique syndrome.3 A taskforce on the topic appointed by the college said that the term “had been used to refer to a subcategory of delirium that has primarily been described retrospectively in the medical examiner literature.”4

A literature review by the taskforce found that people with excited delirium were commonly hyperaggressive with bizarre behaviour, impervious to pain, combative, hyperthermic, and tachycardic. “There is typically a struggle with law enforcement that involves physical, noxious chemical, or [electrical control device] use followed by a period of quiet and sudden death,” the …

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