Recognizing Excited Delirium: A Comprehensive Guide

Excited delirium is a serious and potentially life-threatening condition that can occur suddenly and requires immediate medical attention. Understanding and recognizing the signs and symptoms of excited delirium is crucial for ensuring timely and appropriate intervention. In this blog, we will explore what excited delirium is, its common causes, and how to recognize its symptoms. Excited delirium, also known as agitated delirium, is a state of extreme mental and physiological arousal. It is characterized by a combination of delirium (confusion and disorientation), agitation, aggression, and often a sudden onset of severe hyperactivity. This condition can escalate rapidly and may lead to severe complications, including sudden cardiac arrest. The exact cause of excited delirium is not fully understood, but it is often associated with the following factors:

1. Substance Abuse: The use of stimulants such as cocaine, methamphetamine, and PCP (phencyclidine) is commonly linked to excited delirium. These substances can significantly increase physiological arousal and agitation.
2. Psychiatric Disorders: Individuals with underlying psychiatric conditions, such as schizophrenia or bipolar disorder, may be at a higher risk of developing excited delirium, especially if they are experiencing an acute episode.
3. Medical Conditions: Certain medical conditions, including infections, metabolic imbalances, and severe dehydration, can trigger delirium and agitation.
4. Withdrawal: Withdrawal from substances, particularly alcohol or benzodiazepines, can also lead to delirium and agitation.

1. Hyperthermia: Elevated body temperature is a common sign. The individual may feel extremely hot to the touch and may even remove clothing in an attempt to cool down.
2. Sweating: Excessive sweating, even in cool environments, is often observed.
3. Dilated Pupils: The person's pupils may appear larger than normal.
4. Tachycardia: Rapid heart rate is a significant indicator. The pulse may be extremely fast and strong.
5. Hyperactivity: The individual may exhibit extreme physical activity, restlessness, and an inability to stay still.

1. Agitation and Aggression: The person may become extremely agitated and aggressive, often displaying violent behavior.
2. Disorientation: Confusion and disorientation are common, with the individual being unable to recognize familiar people or places.
3. Paranoia: The person may exhibit paranoid behavior, believing that others are out to harm them.
4. Resistance to Help: Individuals with excited delirium often resist help and may become combative when approached.
5. Unusual Strength: The person may display unusual strength and resistance to physical restraint.

1. Delusions and Hallucinations: The individual may experience delusions (false beliefs) and hallucinations (seeing or hearing things that are not there).
2. Severe Anxiety: Intense anxiety and fear are commonly reported.
3. Incoherent Speech: The person may speak rapidly and incoherently, making it difficult to understand them.

1. Call for Emergency Medical Help: Contact emergency services immediately. Excited delirium is a medical emergency that requires prompt intervention.
2. Ensure Safety: Ensure the safety of the individual and those around them. Keep a safe distance if the person is aggressive, and avoid physical confrontation if possible.
3. Stay Calm: Approach the individual calmly and try to reduce environmental stressors. Speak in a soothing and non-threatening manner.
4. Do Not Restrain: Avoid physically restraining the person unless absolutely necessary, as this can exacerbate their condition and lead to further complications.
5. Provide Information: When emergency responders arrive, provide them with as much information as possible about the individual's behavior, medical history, and any substances they may have used.

August, 2024