[The arrest-related excited delirium syndrome; prevention, treatment and controversies].

BACKGROUND: Patients with an acute confusional state can develop a potentially life-threatening medical emergency when arres­ted by police. This phenomenon has been named the excited delirium syndrome. Controversy regarding this topic has arisen both in the medical literature and in the civil media.

AIM: To provide an overview regarding the pathophysiological, epidemiological and clinical aspects of the excited delirium syndrome, the controversy and the opportunities for prevention of a fatal outcome.

METHOD: A systematic review of the literature from 1985 to 2021.

RESULTS: We included 103 studies in our review. The excited delirium syndrome occurs predominantly in young, physically healthy men who are under the influence of drugs or a psychiatric illness. Several pathophysiological theories exist: the dopaminergic and catecholaminergic hypotheses and restraint asphyxia. There is controversy both in the medical scientific discourse and in the civil media regarding the existence of this syndrome and the cause of death. There are suggestions that mortality can be decreased by timely recognition, de-escalation and medical treatment.

CONCLUSION: The excited delirium syndrome is a medical emergency that can arise during physical arrest of patients with a drugs intoxication or psychiatric illness. Improved collaboration between mental health care professionals and police could prevent fatal outcomes.