[1][2] It has typically been diagnosed postmortem in young adult black males who were physically restrained by law enforcement personnel at the time of death.
[7][8][9] There have been concerns raised over the use by law enforcement and emergency medical personnel partners to inject sedative drugs, a practice nicknamed "policing by needle,"[10] citing claims of excited delirium.
The drugs ketamine or midazolam (a benzodiazepine) and haloperidol (an antipsychotic) injected into a muscle have sometimes been used to sedate a person at the discretion of paramedics and sometimes at direct police request.
[3][12] The term excited delirium is sometimes used interchangeably with acute behavioural disturbance,[13]: 1 a symptom of a number of conditions which is also responded to with involuntary injection with benzodiazepines, antipsychotics, or ketamine.
[14][15]: 152 A 2020 investigation by the United Kingdom Forensic Science Regulator found that the diagnosis should not have been used since it "has been applied in some cases where other important pathological mechanisms, such as positional asphyxia and trauma may have been more appropriate".
"[3] The Royal College of Psychiatrists has deprecated use of excited delirium, recommending non-diagnostic descriptions for highly agitated states such as acute behavioral disturbance.
[18] Throughout the 19th and early-20th century, "excited delirium" was used to describe an emotional and agitated state related to drug overdose[19] and withdrawal[20] or poisonings,[21] similar to catatonia or Bell's mania, with some believing them to be the same condition.
[22] In 1985, an article titled "Cocaine-induced psychosis and sudden death in recreational cocaine users", co-authored by Dade County deputy chief medical examiner Charles Victor Wetli was published in the Journal of Forensic Sciences.
[3] The American Civil Liberties Union argued in 2007 that the diagnosis served "as a means of white-washing what may be excessive use of force and inappropriate use of control techniques by officers during an arrest.
[9][27] Excited delirium has been described as fundamentally racist by many commentators in the media, including Jon Ronson's BBC podcast Things Fell Apart in 2024.
The episode, titled "The Most Mysterious Deaths", describes Wetli's initial coining of the phrase "excited delirium", as well as the later debunking of the phenomenon, and its connection to the murder of George Floyd.
In one case, within four hours of a man dying after being tasered, Axon had provided model press releases, instructions for gathering evidence of excited delirium, and advised that samples be sent to Mash.
[41] In Canada, the 2007 case of Robert Dziekanski received national attention and placed a spotlight on the use of tasers in police actions and the diagnosis of excited delirium.
[48][49][50] Critics of excited delirium have stated that the condition is primarily attributed to deaths while in the custody of law enforcement and is disproportionately applied to Black and Hispanic victims.
[46] Some civil-rights groups have argued that excited delirium diagnoses are being used to absolve law enforcement of guilt in cases where alleged excessive force may have contributed to patient deaths.
[54][55][36] Prominent cases include Daniel Prude, who was said to be in a state of excited delirium in 2020 when police put a hood over his head and pressed his naked body against the pavement.
[57] Ketamine or midazolam and haloperidol injected into a muscle have frequently been used, sometimes at direct police request, to sedate people alleged to be experiencing excited delirium.
[65] Dr. Michael Baden, a specialist in investigating deaths in custody, describes excited delirium as "a boutique kind of diagnosis created, unfortunately, by many of my forensic pathology colleagues specifically for persons dying when being restrained by law enforcement".
[44] In June 2021, the Royal College of Psychiatrists in the UK released a statement that they do "not support the use of such terminology [as ExDS or AgDS], which has no empirical evidential basis" and said "the use of these terms is, in effect, racial discrimination".