'Excited Delirium', acute behavioural disturbance, death and diagnosis.
'Excited Delirium', acute behavioural disturbance, death and diagnosis.
复制标题
“极度妄想症”，急性行为障碍，死亡和诊断。
DOI：
10.1017/s0033291722001076
复制
发表时间：
2022-07
影响因子：
6.9
通讯作者：
Lipsedge, Maurice
中科院分区：
文献类型：
--
作者：
McGuinness, Terry;Lipsedge, Maurice
在20世纪80年代，希波克拉底的传统术语兴奋性谵妄从发热、焦虑和迷失方向的病人的床边移植到了迈阿密的街道上。一些年轻人因吸食可卡因而中毒，并因行为古怪或暴力而被警察制服，他们在拘留期间死亡的原因是兴奋性谵妄。这些受试者的可卡因血药浓度比致死水平低约10倍，其他可能导致致命结果的因素，如警察使用的颈扣、扼喉或“捆猪”，与兴奋性谵妄的重新定义的“诊断”相比，被降级为次要作用。在接下来的几十年里，“兴奋性谵妄”可能适用于几乎任何在公共场所表现出暴力行为的高度激动的人，这些人随后在被约束期间或之后不久死于监禁。专家证人，主要是法医病理学家，作证说，死者的死亡可能是不可避免的，因为兴奋性谵妄的危险性，即使这种诊断缺乏任何一致的神经病理学基础，完全取决于观察到的行为。这个有争议的诊断的兴衰历史是对社会学家菲尔·布朗1995年论文的部分回应，该论文提出了谁受益于，或者至少避免了麻烦，通过识别和使用诊断。
In the 1980s the traditional Hippocratic term excited delirium was transplanted from the bedsides of febrile, agitated and disoriented patients to the streets of Miami. Deaths in custody of young men who were intoxicated with cocaine and who were restrained by the police because of their erratic or violent behaviour were attributed to excited delirium. The blood concentrations of cocaine in these subjects were approximately ten times lower than the lethal level and other factors which might have contributed to the fatal outcome, such as the police use of neck-holds, choke-holds or ‘hog-tying’, were relegated to a minor role compared with the reframed ‘diagnosis’ of excited delirium. Over the course of the next few decades ‘excited delirium’ might be applied to virtually any highly agitated person behaving violently in a public place and who subsequently died in custody while being restrained or shortly afterwards. Expert witnesses, mainly forensic pathologists, testified that the deceased's death was probably inevitable given the perilous nature of excited delirium, even though this diagnostic entity lacked any consistent neuropathological basis and depended entirely on observed behaviour. This history of the rise and fall of this disputed diagnosis is a partial response to the sociologist Phil Brown's 1995 paper asking who benefits, or at least avoids trouble, by the identification and use of a diagnosis.