Excited Delirium Syndrome: Cause of Death and Prevention, 1st Edition (Hardback) book cover

Excited Delirium Syndrome

Cause of Death and Prevention, 1st Edition

By Theresa G. DiMaio, Vincent J.M. DiMaio, M.D.

CRC Press

164 pages | 1 B/W Illus.

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pub: 2005-09-22
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Description

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. 

Reviews

“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

Table of Contents

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

Subject Categories

BISAC Subject Codes/Headings:
LAW041000
LAW / Forensic Science
MED105000
MEDICAL / Psychiatry / General