AAN Position: Excited Delirium
Download the PDF version of Excited Delirium.
“Excited delirium” is a term that has been used to describe non-specific symptoms including severe agitation, erratic behaviors, perceived “imperviousness to pain,” and “superhuman strength.” The term has been used in the context of, or as a rationale for, the administration of ketamine or other sedative/hypnotic or dissociative agents outside of a hospital setting.1 “Excited delirium” lacks clear validated diagnostic criteria. The current body of evidence does not support the use of “excited delirium” as a medical diagnosis, nor does it support substituting a different but similar phrase.
The AAN emphasizes that persons who are agitated, confused, or exhibiting other abnormal behavioral or concerning symptoms, must be evaluated by medical personnel to investigate and address potential underlying causes as these may be due to medical conditions requiring urgent treatment. These symptoms should not be assigned a presumptive cause prior to an appropriate clinical assessment and investigation. It is the AAN’s position that all persons having abnormal behavioral or other concerning symptoms should be thoroughly evaluated by trained medical personnel to determine the most appropriate treatment in accordance with established best practices.
Position Statement History
Drafted by Eva K. Ritzl, MD, FAAN; Altaf Saadi, MD; Vijay K. Ramanan, MD, PhD; Michele Longo, MD, FAAN; Larry B. Goldstein, MD, FAAN, FAHA; Madeline Turbes, MPH (AAN Staff); Justin T. Jordan, MD, MPH, FAAN. Reviewed by Health Policy Subcommittee; Diversity, Equity, and Inclusion Committee; Guidelines Subcommittee; Ethics, Laws and Humanities Committee; Advocacy Committee. Approved by the AAN Board of Directors on March 29, 2024.
1Walsh BM, Agboola IK, Coupet E Jr, Rozel JS, Wong AH. Revisiting "Excited Delirium": Does the Diagnosis Reflect and Promote Racial Bias? West J Emerg Med. 2023 Jan 31;24(2):152-159. doi: 10.5811/westjem.2022.10.56478. PMID: 36976592; PMCID: PMC10047747.