The Experts below are selected from a list of 471 Experts worldwide ranked by ideXlab platform
Deborah C. Mash - One of the best experts on this subject based on the ideXlab platform.
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Excited Delirium and Sudden Death: A Syndromal Disorder at the Extreme End of the Neuropsychiatric Continuum.
Frontiers in physiology, 2016Co-Authors: Deborah C. MashAbstract:Over the past decade, the Excited Delirium syndrome (ExDS) has raised continuous controversy regarding the cause and manner of death of some highly agitated persons who die in police custody, during physical restraint or incapacitation by electrical devices. At autopsy, medical examiners have difficulty in identifying any anatomic cause of death, but frequently cite psychostimulant intoxication as a contributing factor. The characteristic symptoms of ExDS include bizarre and aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia. Throughout the United States and Canada, these cases are most frequently associated with cocaine, methamphetamine and designer cathinone abuse. Acute exhaustive mania and sudden death presents with behavioral symptoms that are identical to what is described for ExDs in psychostimulant abusers. Bell’s mania or acute exhaustive mania was first described in the 1850’s by American psychiatrist Luther Bell in institutionalized psychiatric patients. This rare disorder of violent mania, elevated body temperature and autonomic collapse continued to be described by others in the psychiatric literature, but with different names until the first cases of ExDS were recognized at the beginning of the cocaine epidemic by medical examiners. The first neurochemical pathology examinations of brain tissues from these cases after death revealed a loss of dopamine transporter regulation together with increases in heat shock protein 70 (hsp70) expression as a biomarker of hyperthermia. The similarity in the behavioral symptoms between extremely agitated psychostimulant abusers and unmedicated psychiatric patients suggests that a genetic disorder that leads to dysregulated central dopamine transporter function could be a precipitating cause of the acute Delirium and sudden death. While the precise cause and mechanism of lethality remains controversial, the likely whys and wherefores of sudden death of ExDS victims are seen to be “biological”, since excessive dopamine in the brain triggers the manic excitement and Delirium, which unabated, culminates in a loss of autonomic function that progresses to cardiorespiratory collapse.
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Excited Delirium syndrome exds defining based on a review of the literature
Journal of Emergency Medicine, 2012Co-Authors: Gary M. Vilke, Mark L. Debard, Theodore C. Chan, Donald M. Dawes, Christine Hall, Michael Curtis, Melissa Wysong Costello, Jeffrey D Ho, Deborah C. MashAbstract:Abstract Background Patients present to police, Emergency Medical Services, and the emergency department with aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, “superhuman” strength, diaphoresis, and lack of willingness to yield to overwhelming force. A certain percentage of these individuals will go on to expire from a sudden cardiac arrest and death, despite optimal therapy. Traditionally, the forensic community would often classify these as “Excited Delirium” deaths. Objectives This article will review selected examples of the literature on this topic to determine if it is definable as a discrete medical entity, has a recognizable history, epidemiology, clinical presentation, pathophysiology, and treatment recommendations. Discussion Excited Delirium syndrome is characterized by Delirium, agitation, acidosis, and hyperadrenergic autonomic dysfunction, typically in the setting of acute-on-chronic drug abuse or serious mental illness or a combination of both. Conclusions Based upon available evidence, it is the consensus of an American College of Emergency Physicians Task Force that Excited Delirium Syndrome is a real syndrome with uncertain, likely multiple, etiologies.
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Excited Delirium Syndrome (ExDs)
The Journal of emergency medicine, 2011Co-Authors: Gary M. Vilke, Mark L. Debard, Theodore C. Chan, Donald M. Dawes, Christine Hall, Michael Curtis, Melissa Wysong Costello, Deborah C. Mash, Stewart R. CoffmanAbstract:Patients present to police, Emergency Medical Services, and the emergency department with aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, "superhuman" strength, diaphoresis, and lack of willingness to yield to overwhelming force. A certain percentage of these individuals will go on to expire from a sudden cardiac arrest and death, despite optimal therapy. Traditionally, the forensic community would often classify these as "Excited Delirium" deaths. This article will review selected examples of the literature on this topic to determine if it is definable as a discrete medical entity, has a recognizable history, epidemiology, clinical presentation, pathophysiology, and treatment recommendations. Excited Delirium syndrome is characterized by Delirium, agitation, acidosis, and hyperadrenergic autonomic dysfunction, typically in the setting of acute-on-chronic drug abuse or serious mental illness or a combination of both. Based upon available evidence, it is the consensus of an American College of Emergency Physicians Task Force that Excited Delirium Syndrome is a real syndrome with uncertain, likely multiple, etiologies. Copyright © 2012 Elsevier Inc. All rights reserved.
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Brain biomarkers for identifying Excited Delirium as a cause of sudden death.
Forensic science international, 2009Co-Authors: Deborah C. Mash, Linda Duque, John Pablo, Yujing Qin, Nikhil Adi, W Lee Hearn, Bruce A Hyma, Steven B Karch, Henrik Druid, Charles V. WetliAbstract:Excited Delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the Delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety Excited Delirium deaths and present results on the association of a 2-protein biomarker signature. We conducted quantitative analyses of the dopamine transporter and heat shock protein 70 validated for specificity and degree of interindividual variation. Incident circumstances, force measures, autopsy and toxicology results were determined for all subjects. A majority of the victims in this case series tested positive for cocaine in blood and brain, although four had no licit or illicit drugs or alcohol measured at autopsy. Mean core body temperature where recorded was 40.7 degrees C. The expression of the heat shock protein HSPA1B transcript was elevated 1.8-4-fold in postmortem brain. The elevation of Hsp70 in autopsy brain specimens confirms that hyperthermia is an associated symptom and often a harbinger of death in these cases. Dopamine transporter levels were below the range of values measured in age-matched controls, providing pathologic evidence for increased risk of chaotic dopamine signaling in Excited Delirium. When combined with descriptions of the decedents' behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the Excited Delirium syndrome at autopsy.
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Brain biomarkers for identifying Excited Delirium as a cause of sudden death.
Forensic Science International, 2009Co-Authors: Deborah C. Mash, Linda Duque, John Pablo, Yujing Qin, Nikhil Adi, W Lee Hearn, Bruce A Hyma, Steven B Karch, Henrik Druid, Charles V. WetliAbstract:Excited Delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the Delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety Excited Delirium deaths and present results on the association of a 2-protein biomarker signature. We conducted quantitative analyses of the dopamine transporter and heat shock protein 70 validated for specificity and degree of interindividual variation. Incident circumstances, force measures, autopsy and toxicology results were determined for all subjects. A majority of the victims in this case series tested positive for cocaine in blood and brain, although four had no licit or illicit drugs or alcohol measured at autopsy. Mean core body temperature where recorded was 40.7 8C. The expression of the heat shock protein HSPA1B transcript was elevated 1.8–4-fold in postmortem brain. The elevation of Hsp70 in autopsy brain specimens confirms that hyperthermia is an associated symptom and often a harbinger of death in these cases. Dopamine transporter levels were below the range of values measured in age-matched controls, providing pathologic evidence for increased risk of chaotic dopamine signaling in Excited Delirium. When combined with descriptions of the decedents’ behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the Excited Delirium syndrome at autopsy.
Charles V. Wetli - One of the best experts on this subject based on the ideXlab platform.
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Electrical weapons and Excited Delirium: shocks, stress, and serum serotonin
Forensic Science Medicine and Pathology, 2018Co-Authors: Mark W. Kroll, Charles V. Wetli, Stacey L. Hail, Ryan M. Kroll, John C. CriscioneAbstract:It has been suggested that a CEW (conducted electrical weapon) exposure could elicit a stress response that could cause ExDS (Excited Delirium syndrome). There are some parallels between the signs of ExDS and serotonin syndrome (SS). Electroconvulsive therapy raises serotonin levels and therefore provides a plausible link between CEW applications and elevated serotonin levels. This study was designed to determine whether a CEW exposure elevates serum serotonin. A total of 31 police academy cadets were exposed to a very broad-spread 5-s CEW stimulus from a TASER brand X26 CEW. Blood was drawn before and after the exposure and at 24 h post exposure to measure serum serotonin levels. Lactic acid and cortisol levels were also compared. Median serum serotonin levels were 30 IQR (21,46), 36 IQR (22,50), and 32 IQR (21,45) ng/mL before exposure, after exposure, and 24 h after exposure (NS by pooled comparisons). The increase from baseline to post-test serotonin (∆ median = +6, ∆ mean = +2.7) ng/mL was not significant by a paired T-test ( p = .29) but was significant by the Wilcoxon signed-rank test ( p = .037). The increase to post-test log serotonin was not significant by a paired T-test ( p = .13) but was significant by the Wilcoxon test ( p = .049). All serotonin levels remained within the normal reference range of 0–200 ng/mL. Post-hoc analysis demonstrated that the study was powered to detect a ½ SD change, in log serotonin, with a 90% likelihood. With a very-broad electrode spread, CEW exposure did not significantly raise serum serotonin levels.
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Brain biomarkers for identifying Excited Delirium as a cause of sudden death.
Forensic Science International, 2009Co-Authors: Deborah C. Mash, Linda Duque, John Pablo, Yujing Qin, Nikhil Adi, W Lee Hearn, Bruce A Hyma, Steven B Karch, Henrik Druid, Charles V. WetliAbstract:Excited Delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the Delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety Excited Delirium deaths and present results on the association of a 2-protein biomarker signature. We conducted quantitative analyses of the dopamine transporter and heat shock protein 70 validated for specificity and degree of interindividual variation. Incident circumstances, force measures, autopsy and toxicology results were determined for all subjects. A majority of the victims in this case series tested positive for cocaine in blood and brain, although four had no licit or illicit drugs or alcohol measured at autopsy. Mean core body temperature where recorded was 40.7 8C. The expression of the heat shock protein HSPA1B transcript was elevated 1.8–4-fold in postmortem brain. The elevation of Hsp70 in autopsy brain specimens confirms that hyperthermia is an associated symptom and often a harbinger of death in these cases. Dopamine transporter levels were below the range of values measured in age-matched controls, providing pathologic evidence for increased risk of chaotic dopamine signaling in Excited Delirium. When combined with descriptions of the decedents’ behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the Excited Delirium syndrome at autopsy.
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Brain biomarkers for identifying Excited Delirium as a cause of sudden death.
Forensic science international, 2009Co-Authors: Deborah C. Mash, Linda Duque, John Pablo, Yujing Qin, Nikhil Adi, W Lee Hearn, Bruce A Hyma, Steven B Karch, Henrik Druid, Charles V. WetliAbstract:Excited Delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the Delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety Excited Delirium deaths and present results on the association of a 2-protein biomarker signature. We conducted quantitative analyses of the dopamine transporter and heat shock protein 70 validated for specificity and degree of interindividual variation. Incident circumstances, force measures, autopsy and toxicology results were determined for all subjects. A majority of the victims in this case series tested positive for cocaine in blood and brain, although four had no licit or illicit drugs or alcohol measured at autopsy. Mean core body temperature where recorded was 40.7 degrees C. The expression of the heat shock protein HSPA1B transcript was elevated 1.8-4-fold in postmortem brain. The elevation of Hsp70 in autopsy brain specimens confirms that hyperthermia is an associated symptom and often a harbinger of death in these cases. Dopamine transporter levels were below the range of values measured in age-matched controls, providing pathologic evidence for increased risk of chaotic dopamine signaling in Excited Delirium. When combined with descriptions of the decedents' behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the Excited Delirium syndrome at autopsy.
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Cocaine-Associated Rhabdomyolysis and Excited Delirium: Different Stages of the Same Syndrome
The American journal of forensic medicine and pathology, 1999Co-Authors: A. J. Ruttenber, Heath B. Mcanally, Charles V. WetliAbstract:Previous case reports indicate that cocaine-associated rhabdomyolysis and Excited Delirium share many similar features, suggesting that they may be different stages of the same syndrome. We tested this hypothesis by comparing data from 150 cases of cocaine-associated rhabdomyolysis reported in the medical literature with data from an autopsy registry for 58 victims of fatal Excited Delirium and 125 victims of fatal acute cocaine toxicity. Patients with rhabdomyolysis are similar to victims of fatal Excited Delirium with regard to age; gender; race; route of cocaine administration; the experiencing of excitement, Delirium, and hyperthermia; and the absence of seizures. Compared with victims of fatal acute cocaine toxicity, patients with rhabdomyolysis are different with regard to each of these variables. Compared with victims of fatal acute cocaine toxicity, both victims of rhabdomyolysis and fatal Excited Delirium are more likely to be black, male, and younger; to have administered cocaine by smoking or injection; and to have experienced excitement, Delirium, and hyperthermia; they are also less likely to have had seizures. Because cocaine-associated rhabdomyolysis and Excited Delirium have similar clinical features and risk factors, occur in similar populations of drug users, and can be explained by the same pathophysiologic processes, we conclude that they are different stages of the same syndrome. It appears that this syndrome is caused by changes in dopamine processing induced by chronic and intense use of cocaine rather than by the acute toxic effects of the drug.
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Fatal Excited Delirium following cocaine use: epidemiologic findings provide new evidence for mechanisms of cocaine toxicity.
Journal of forensic sciences, 1997Co-Authors: A. J. Ruttenber, Charles V. Wetli, J Lawler-heavner, M I N G Yin, W. L. Hearn, Deborah C. MashAbstract:We describe an outbreak of deaths from cocaine-induced Excited Delirium (EDDs) in Dade County, Florida between 1979 and 1990. From a registry of all cocaine-related deaths in Dade County, Florida, from 1969-1990, 58 EDDs were compared with 125 victims of accidental cocaine overdose without Excited Delirium. Compared with controls, EDDs were more frequently black, male, and younger. They were less likely to have a low body mass index, and more likely to have died in police custody, to have received medical treatment immediately before death, to have survived for a longer period, to have developed hyperthermia, and to have died in summer months. EDDs had concentrations of cocaine and benzoylecgonine in autopsy blood that were similar to those for controls. The epidemiologic findings are most consistent with the hypothesis that chronic cocaine use disrupts dopaminergic function and, when coupled with recent cocaine use, may precipitate agitation, Delirium, aberrant thermoregulation, rhabdomyolysis, and sudden death.
Luigia Trabace - One of the best experts on this subject based on the ideXlab platform.
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The role of the NADPH oxidase derived brain oxidative stress in the cocaine-related death associated with Excited Delirium: A literature review.
Toxicology letters, 2016Co-Authors: Stefania Schiavone, Luigia Trabace, Margherita Neri, Emanuela Mhillaj, Cristoforo Pomara, Emanuela TurillazziAbstract:Excited Delirium syndrome (ExDS) is a term used to describe a clinical condition characterized by bizarre and aggressive behaviour, commonly associated with the use of psychoactive compounds, especially cocaine. The pathophysiology of ExDS is complex and not yet fully understood. In addition to a central dopamine hypothesis, other mechanisms are thought to be involved in cocaine-related ExDS, such as increased reactive oxygen species production by the family of the NADPH oxidase NOX enzymes. In this review, we will summarize current knowledge on the crucial contribution of brain NADPH oxidase derived oxidative stress in the development of cocaine-induced ExDS. Data from animal models as well as human evidence will be discussed.
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Involvement of the NADPH Oxidase NOX2-Derived Brain Oxidative Stress in an Unusual Fatal Case of Cocaine-Related Neurotoxicity Associated With Excited Delirium Syndrome.
Journal of clinical psychopharmacology, 2016Co-Authors: Stefania Schiavone, Irene Riezzo, Emanuela Turillazzi, Luigia TrabaceAbstract:Here, we investigated the possible role of the Nicotinamide Adenine Dinucleotide Phosphate oxidase NOX2-derived brain oxidative stress in a fatal case of cocaine-related neurotoxicity, associated to Excited Delirium syndrome. We detected a strong NOX2 immunoreactivity, mainly in cortical GABAergic neurons and astrocytes, with a minor presence in microglia, glutamatergic and dopaminergic neurons as well as a significant immunostaining for other markers of oxidative stress (8OhDG, HSP70, HSP90, and NF-κB) and apoptotic phenomena. These results support a crucial role of NOX2-derived brain oxidative stress in cocaine-induced brain dysfunctions and neurotoxicity.
William K. Milne - One of the best experts on this subject based on the ideXlab platform.
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Hot Off the Press: SGEM #218. Excited Delirium: A Systematic Review.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2018Co-Authors: Christopher Bond, Justin Morgenstern, Corey Heitz, William K. MilneAbstract:This systematic review provides an assessment of the Excited Delirium syndrome (ExDS), including definition, epidemiology, pathophysiology, and management. Sixty-six relevant articles were included with significant heterogeneity of selected studies and poor overall quality. A quantitative meta-analysis could not be performed because there remains no clear definition for ExDS, however, this study does provide useful information regarding epidemiology, pathophysiology, and treatment of ExDS.
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hot off the press sgem 218 Excited Delirium a systematic review
Academic Emergency Medicine, 2018Co-Authors: Christopher Bond, Justin Morgenstern, Corey Heitz, William K. MilneAbstract:This systematic review provides an assessment of the Excited Delirium syndrome (ExDS), including definition, epidemiology, pathophysiology, and management. Sixty-six relevant articles were included with significant heterogeneity of selected studies and poor overall quality. A quantitative meta-analysis could not be performed because there remains no clear definition for ExDS, however, this study does provide useful information regarding epidemiology, pathophysiology, and treatment of ExDS.
Steven B Karch - One of the best experts on this subject based on the ideXlab platform.
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1570-159X/15 $58.00+.00 ©2015 Bentham Science Publishers
2016Co-Authors: Cathinone Neurotoxicity “ms, Steven B KarchAbstract:Abstract: Synthetic cathinones are designer drugs of the phenethylamine class, structurally and pharmacologically similar to amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cathinone and other related substances. New analogues, legal at least, until formally banned (a time consuming process), are introduced almost daily The United Nations estimates nearly 250 new drug analogues are produced per year. Various combinations of these drugs are sold under the name of “bath salts. ” They can be ingested by any route and some appear capable of causing great harm, mostly behavioral. One drug in particular, MDVP, appears to frequently cause symptoms indistinguishable from the classic findings in Excited Delirium Syndrome (ExDS). Little is known about the pathology or clinical toxicology of these drugs but their molecular mechanism of action seems to be identical with that of cocaine. This mini-review examines what little is known on the subject and explains the suspected mechanisms of Excited Delirium syndrome
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Cathinone neurotoxicity ("The "3Ms").
Current neuropharmacology, 2015Co-Authors: Steven B KarchAbstract:Synthetic cathinones are designer drugs of the phenethylamine class, structurally and pharmacologically similar to amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cathinone and other related substances. New analogues, legal at least, until formally banned (a time consuming process), are introduced almost daily The United Nations estimates nearly 250 new drug analogues are produced per year. Various combinations of these drugs are sold under the name of “bath salts”. They can be ingested by any route and some appear capable of causing great harm, mostly behavioral. One drug in particular, MDVP, appears to frequently cause symptoms indistinguishable from the classic findings in Excited Delirium Syndrome (ExDS). Little is known about the pathology or clinical toxicology of these drugs but their molecular mechanism of action seems to be identical with that of cocaine. This mini-review examines what little is known on the subject and explains the suspected mechanisms of Excited Delirium syndrome.
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Possible Strategies for the Diagnosis of Fatal Excited Delirium Syndrome
Academic Forensic Pathology, 2012Co-Authors: Steven B KarchAbstract:Excited Delirium Syndrome (ExDS) is a term traditionally used in forensic literature to describe the symptoms and signs seen in a subgroup of patients with Delirium who die in an agitated state. Co...
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Excited Delirium syndrome (ExDS): Redefining an old diagnosis
Journal of forensic and legal medicine, 2011Co-Authors: Gary M. Vilke, Jason Payne-james, Steven B KarchAbstract:Recently, the National Institute of Justice (NIJ) of the United States of America convened a meeting of experts in the area of Excited Delirium Syndrome (ExDS). The history of ExDS, the clinical presentation, the pathophysiology, differential diagnoses and management options were discussed. Though the specific pathophysiological pathways of ExDS have yet to be formally defined, considerable research has been undertaken on this topic. It is important for law enforcement, medical and other healthcare professionals to be familiar with current knowledge about the syndrome. This paper summarizes the current state and knowledge of ExDS.
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Brain biomarkers for identifying Excited Delirium as a cause of sudden death.
Forensic science international, 2009Co-Authors: Deborah C. Mash, Linda Duque, John Pablo, Yujing Qin, Nikhil Adi, W Lee Hearn, Bruce A Hyma, Steven B Karch, Henrik Druid, Charles V. WetliAbstract:Excited Delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the Delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety Excited Delirium deaths and present results on the association of a 2-protein biomarker signature. We conducted quantitative analyses of the dopamine transporter and heat shock protein 70 validated for specificity and degree of interindividual variation. Incident circumstances, force measures, autopsy and toxicology results were determined for all subjects. A majority of the victims in this case series tested positive for cocaine in blood and brain, although four had no licit or illicit drugs or alcohol measured at autopsy. Mean core body temperature where recorded was 40.7 degrees C. The expression of the heat shock protein HSPA1B transcript was elevated 1.8-4-fold in postmortem brain. The elevation of Hsp70 in autopsy brain specimens confirms that hyperthermia is an associated symptom and often a harbinger of death in these cases. Dopamine transporter levels were below the range of values measured in age-matched controls, providing pathologic evidence for increased risk of chaotic dopamine signaling in Excited Delirium. When combined with descriptions of the decedents' behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the Excited Delirium syndrome at autopsy.
