Abstract

Custodial Deaths (CD), especially those in police custody, are usually viewed with suspicion. Often, the allegations of custodial violence or torture against the custodians are unwarranted and far from reality. Sometimes natural deaths are suspected as custodial violence due to unclear clinical and/or pathological signs. One such tricky medical condition is Excited Delirium Syndrome (ExDS). Its common clinical presentations, like delirium, psychomotor agitation, and violent excitation, are usually misinterpreted as the violent behaviour of the detained person. This leads to a vicious cycle of violent frenzy episodes and increased restraint between the detainee and the custodians, complicating the situation further. The pathology behind ExDS is unknown and still research works going on to determine an apparent pathogenesis of it. ExDS often results in law-and-order situations due to its bizarre clinical presentation, necessitating the use of substantial force to restrain the violent patient physically. Hence, an allegation of human rights violation by the family members, civil society or media is potentially associated with ExDS due to signs of physical restraint and violence on the body of the individual. Forensic pathologists usually diagnose ExDS retrospectively by diagnosing exclusion after performing a comprehensive autopsy and toxicological analysis. This paper is a case-based review of some fatal custodial deaths that occurred in deaddiction centres. There was history of cannabis and alcohol addiction in both cases. The aim of this paper is to highlight the scenarios of clinical presentation of ExDS cases and possible measures for early identification of ExDS and preventing such custodial deaths.

Keywords: excited delirium syndrome; custody; death; agitation; delirium; addiction