Doctors, police in conflict over excited delirium deaths

September 2, 2007
Kate McGinty, Appleton Post-Crescent (Wisconsin)

"While police are taught to treat excited delirium as a medical condition — and to control the person's aggressiveness by using a Taser — most of the medical community insists excited delirium is not, in fact, a medical diagnosis. "Excited delirium is not a term that is recognized, so (in the case of) nonmedical people who use the term, it's very difficult to determine exactly what they mean," said Dr. William Narrow, associate director of the division of research at the American Psychiatric Association. The American Medical Association, whose Web site returns no search results for the term excited delirium, defers to Narrow's opinion, said spokeswoman Lisa Bevilacqua. Excited delirium may well exist but falls short of a medical explanation for a death, said Dr. Michael A. Williams, chairman of the ethics committee for the American Academy of Neurology and medical director of the LifeBridge Brain and Spine Institute in Baltimore. What police officers and coroners are describing as excited delirium seems to be a syndrome, he said. "A syndrome is just a collection of symptoms," he said. "A syndrome describes symptoms of behaviors or a typical series of events ... that seem to be consistent among a certain group of people. "But the diagnosis is the next step. When doctors say diagnosis, they're thinking a particular cause, something I can see under a microscope or a blood test I can give." A given syndrome can have several causes or diagnoses, Williams said. "When the coroner says excited delirium, it's not clear to me what single pathological entity is supposed to be causing that," he said. "When somebody says excited delirium, the next thing they should say is, 'caused by diagnosis A, diagnosis B, diagnosis C.' "Excited delirium doesn't cause itself. Something causes excited delirium."

... Being more specific about excited delirium is not so easy, said Dr. Joe Prahlow, president of the National Medical Examiners Association. "In cases of excited delirium, there is no anatomical cause of death," he said. Identifying a factor that makes a death clearly caused by excited delirium is nearly impossible. "That's the million-dollar question," he said."