1st Edition

Excited Delirium Syndrome Cause of Death and Prevention

    160 Pages 1 B/W Illustrations
    by CRC Press

    During a routine investigation, a suspect turns hostile. The officers on the scene spring into action and get the suspect  under control by handcuffing him. Though the suspect has been successfully subdued – he dies shortly thereafter…

    A psychiatric patient suddenly becomes violent. The hospital staff struggles to control the patient with four point restraint. While order has been restored and the patient has been restrained – she dies soon afterward…

    Criminal and civil cases often cite “positional asphyxia” as the cause of death in such instances, blaming the rough treatment individuals may have received during restraint. The authors of Excited Delirium Syndrome: Cause of Death and Prevention, however, propose a different explanation. In this groundbreaking book, they cite the reason being a condition called Excited Delirium Syndrome, in which the normal physiological changes produced by violent activity culminate in sudden cardiac death, often in conjunction with the effects of a drug. 

    After introducing the topic, the book recounts the condition’s history and examines traditional explanations as to why such deaths occur, and then counter as to why they are not justifiable. In addition, it illustrates the effects that stressors, legal medication, and drugs of abuse have on the cardiovascular system. The effects of underlying disease, including endogenous mental disease are also discussed. In addition, the book details prevention, assesses the role of first responders, investigators, and mental health professionals, and describes “high-risk” individuals.

    These topics, along with the many actual case studies that provide further insight, make Excited Delirium Syndrome: Cause of Death and Prevention an essential resource for anyone treating or interacting with those that may have this disorder. 

    INTRODUCTION TO DEATH DUE TO EXCITED DELIRIUM SYNDROME
    References
    HISTORY OF EXCITED DELIRIUM SYNDROME 
    Bell’s Mania
    Current Cases
    Psychopharmacology and the Disappearance of the Chronic Form of Excited Delirium
    Acute Excited Delirium
    References
    TRADITIONAL EXPLANATIONS FOR DEATH DUE TO EXCITED DELIRIUM SYNDROME
    Medical Examiner
    Positional/Restraint Asphyxia
    Neck Holds
    Vasovagal Reactions (Reflex Cardiac Death)
    Oleresin Capsicum
    Tasers
    Explaining Excited Delirium Syndrome 
    References
    PHYSIOLOGICAL REACTIONS TO STRESS
    The Sympathetic Nervous System
    Physiological Effects of Strenuous/Violent Physical Activity
    References
    EFFECTS OF DRUGS ON THE HEART, BRAIN, AND SYMPATHETIC NERVOUS SYSTEM
    Cardiac Injury Due to Chronic Elevation of Blood
       Catecholamine Levels
    Psychotropic Drugs and Sudden Death
    Miscellaneous Drugs
    References
    Additional References
    SYNTHESIS OF PHYSIOLOGICAL REACTIONS TO STRESS, NATURAL DISEASE, DRUGS OF ABUSE, AND MEDICATIONS IN CASES OF EXCITED DELIRIUM
    References
    MEDICO-LEGAL INVESTIGATION OF DEATHS DUE TO EXCITED DELIRIUM SYNDROME
    The Investigation
    The Autopsy
    Toxicology
    Certification of Death
    References
    CASES OF EXCITED DELIRIUM SYNDROME
    Excited Delirium Syndrome Associated with Mental Illness and
       Natural Disease
    Excited Delirium Syndrome Associated with Mental Retardation and Obesity
    Excited Delirium Syndrome Associated with Mental Illness and
       Therapeutic Medications
    Excited Delirium Syndrome Associated with Use of Cocaine
    Excited Delirium Syndrome in Association with Methamphetamine
    Excited Delirium Syndrome in Association with Other Drugs
    PREVENTION OF EXCITED DELIRIUM SYNDROME: THE POLICE AND FIRST RESPONDERS
    Introduction
    The Problem
    Law Enforcement
    Prevention
    Emergency Responders
    Police and EMS at the Scene
    Emergency Rooms
    References
    SUDDEN DEATH OF THE PSYCHIATRIC PATIENT IN MENTAL HEALTH FACILITIES
    Introduction
    Identifying Patients Susceptible to Excited Delirium Syndrome
    Preventing Sudden Death from Excited Delirium Syndrome
    Overview of Preventive Measures
    Conclusion
    References
    INDEX

    Biography

    Theresa G. DiMaio (Author) , Vincent J. M. DiMaio, M.D. (Author)

    “This short, easy-to-read, 10-chapter book provides current information on the syndrome, dispels common myths, and provides prevention strategies on how to interact with individuals experiencing and excited delirium. It also provides a well-constructed discussion of the chronology of the mechanism resulting in sudden death during an episode of excited delirium with extensive references. … will be of greatest benefit for nurses who interact with psychiatric patients. It outlines the features used to identify patients susceptible to excited delirium and the actions to prevent sudden death. … is a useful reference tool for both legal and medical professionals who may come face-to-face with an individual exhibiting these symptoms. The chapters are well organized and laid out, easy to read, and provide useful information and references. Again, this book is an excellent resource to all members of the law enforcement, forensic, investigation, treatment, and prosecuting teams. …”
    — Steven A. Koehler, Forensic Epidemiologist for the Allegheny County Coroner’s Office, Pittsburg, PA, in the Journal of Forensic Nursing, Vol. 2, No. 4, Winter 2006

    "The authors’ poignant description of what those who work in the trenches experience on a daily basis is alone worth the read and rounds out the entire discussion."

    – Kathryn A. LaFortune, Chief, Forensic Psychological Services, Oklahoma Indigent Defense System, in Jurimetrics, Winter 2008, Vol. 48, No. 2