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Debate around 'excited delirium' diagnosis

Natasha McKenna weighed only 130 pounds, but six deputies struggled to restrain her at the Fairfax County jail in February. They handcuffed, shackled, hit and wrestled the mentally ill woman, all with great effort, they said, for more than 20 minutes, before shocking her into submission with a Taser. Minutes later, she stopped breathing. Days later, she died.

But, reports The Washington Post, when the Virginia medical examiner's office issued the cause of her death last week, it declared that the Taser and use of force were not the primary factors. Instead, it was a rare and controversial syndrome that has been cited in dozens of deaths across the country after struggles with law enforcement: excited delirium.

Police, medical examiners and some doctors say the condition is real and frightening. Influenced by mental illness or the use of such stimulants as cocaine and methamphetamine, those in its grip often have extraordinary strength, are impervious to pain and act wildly or violently. Then, suddenly, some die. But, the report says, other medical experts and civil libertarians have questioned the existence of excited delirium and its frequent citation in cases that involve violent encounters between police and members of the public. Some say it is a cover for the use of excessive force by law enforcement.

Vincent Di Maio, a retired forensic pathologist who has written a book on excited delirium, said that McKenna sounded like a prime candidate for the syndrome, given her history of mental illness and her struggle with officers. The condition has been "well documented," he said, adding that critics are misguided in arguing that it does not exist. "The original idea was noted in 1849 — if you go to medical literature, it shows up again and again over the years," Di Maio said. "There's no major scientific objection to it." Di Maio estimated there were 600 to 800 cases a year nationwide in the US.

Deborah C Mash, a professor of neurology at the University of Miami, said schizophrenics, bipolar patients and users of cocaine and methamphetamine are particularly prone to excited delirium. Their heart rates soar, and they become paranoid and delusional. Body temperatures can reach 105 degrees or higher.

The physiological mechanism of the syndrome is complex and remains poorly understood, but Mash said it probably involves an excess of neurotransmitters in the brain used to regulate organ functions. "The signals between the heart and brain become chaotic. Normally, you have a feedback mechanism that will help to normalise respiration and cardiac rate and rhythm, but these fail," Mash said. "The brain can be cooked."

There is no consensus on excited delirium among major medical groups. The American College of Emergency Physicians and the National Association of Medical Examiners recognise the condition, but others – including the American Medical Association and American Psychological Association – have not taken a stand.

"We are … aware of an ongoing debate within the professional literature about such a diagnosis," the APA said. "Ultimately, more research on the concept of 'excited delirium' needs to be undertaken."

[link url="http://www.washingtonpost.com/local/crime/existence-of-excited-delirium-ruling-in-va-womans-death-has-experts-split/2015/05/06/b1cc9499-ddaa-474c-9e8a-9ae89a9ae679_story.html"]Full report in The Washington Post[/link]

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