Advertisement

Electrical weapons and excited delirium: shocks, stress, and serum serotonin

  • Mark W. Kroll
  • Stacey L. Hail
  • Ryan M. Kroll
  • Charles V. Wetli
  • John C. Criscione
Original Article

Abstract

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.

Keywords

Force TASER Weapon CEW Serotonin Excited delirium 

Notes

Funding

Unites States Joint Non-Lethal Weapons Program. W911QY-08-C-0023.

Compliance with ethical standards

Conflict of interest

Authors 1, 2, and 4 have been expert witnesses in use-of-force litigation. Author 1 is a member of the scientific advisory and corporate boards of Axon Enterprises, Inc. (fka TASER Intl, Inc.).

Ethical approval

Institutional Review Board of Texas A&M University.

Informed consent

Consent forms were obtained from all subjects before inclusion in this study. Participants were cadets from the Austin (Texas) Police Academy who had previously volunteered to undergo a CEW exposure as part of their training.

Supplementary material

12024_2018_5_MOESM1_ESM.pdf (371 kb)
ESM 1 (PDF 370 kb)

References

  1. 1.
    Vilke GM, Bozeman WP, Dawes DM, Demers G, Wilson MP. Excited delirium syndrome (ExDS): treatment options and considerations. J Forensic Legal Med. 2012;19:117–21.CrossRefGoogle Scholar
  2. 2.
    Lee BK, Vittinghoff E, Whiteman D, Park M, Lau LL, Tseng ZH. Relation of Taser (electrical stun gun) deployment to increase in in-custody sudden deaths. Am J Cardiol. 2009;103:877–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Soleimanirahbar A, Lee B. The TASER safety controversy. Expert Rev Med Devices. 2011;8:661–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Krystal AD, Weiner RD. ECT seizure duration: reliability of manual and computer-automated determinations. Convuls Ther. 1995;11:158–69.PubMedGoogle Scholar
  5. 5.
    Nilsen SM, Willis KW, Pettinati HM. Initial impression of two new brief-pulse electroconvulsive therapy machines. Convuls Ther. 1986;2:43–54.PubMedGoogle Scholar
  6. 6.
    Kroll M, Brave M. TASER® conducted electrical weapons. In: Ra V, editor. Guidelines for investigating officer involved shootings, arrest-related deaths, and deaths in custody. Rutledge: Taylor and Francis; 2017. p. 246–71.Google Scholar
  7. 7.
    Hasani PAM, Mokhtaree M, Fatemeh M, Mohammad N. Effect of electroconvulsive therapy on serum serotonin level in patients with treatment–resistant major depressive disorder. Europ Psychiat. 2017;41:S138.CrossRefGoogle Scholar
  8. 8.
    Deuschle M, Bohringer A, Meyer-Lindenberg A, Sartorius A. Electroconvulsive therapy induces transient sensitivity for a serotonin syndrome: a case report. Pharmacopsychiatry. 2017;50:41–2.PubMedGoogle Scholar
  9. 9.
    Cheng YC, Liang CM, Liu HC. Serotonin syndrome after electroconvulsive therapy in a patient on trazodone, bupropion, and quetiapine: a case report. Clin Neuropharmacol. 2015;38:112–3.PubMedGoogle Scholar
  10. 10.
    Okamoto N, Sakamoto K, Yamada M. Transient serotonin syndrome by concurrent use of electroconvulsive therapy and selective serotonin reuptake inhibitor: a case report and review of the literature. Case Rep Psychiatry. 2012;2012:215214.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Okamoto N, Sakamoto K, Nagafusa Y, Ichikawa M, Nakai T, Higuchi T. Electroconvulsive therapy as a potentially effective treatment for severe serotonin syndrome: two case reports. J Clin Psychopharmacol. 2010;30:350–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Nisijima K, Nibuya M, Kato S. Toxic serotonin syndrome successfully treated with electroconvulsive therapy. J Clin Psychopharmacol. 2002;22:338–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Ohmatsu S, Nakano H, Tominaga T, Terakawa Y, Murata T, Morioka S. Activation of the serotonergic system by pedaling exercise changes anterior cingulate cortex activity and improves negative emotion. Behav Brain Res. 2014;270:112–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Nakatani Y, Sato-Suzuki I, Tsujino N, Nakasato A, Seki Y, Fumoto M, et al. Augmented brain 5-HT crosses the blood-brain barrier through the 5-HT transporter in rat. Eur J Neurosci. 2008;27:2466–72.CrossRefPubMedGoogle Scholar
  15. 15.
    Audhya T, Adams JB, Johansen L. Correlation of serotonin levels in CSF, platelets, plasma, and urine. Biochim Biophys Acta. 1820;2012:1496–501.Google Scholar
  16. 16.
    Ho J, Dawes D, Miner J, Kunz S, Nelson R, Sweeney J. Conducted electrical weapon incapacitation during a goal-directed task as a function of probe spread. Forensic Sci Med Pathol. 2012;8:358–66.CrossRefPubMedGoogle Scholar
  17. 17.
    Kunz SN, Calkins HG, Adamec J, Kroll MW. Adrenergic and metabolic effects of electrical weapons: review and meta-analysis of human data. Int J Legal Med. 2018;  https://doi.org/10.1007/s00414-018-1771-2.
  18. 18.
    Vilke GM, Bozeman WP, Chan TC. Emergency department evaluation after conducted energy weapon use: review of the literature for the clinician. J Emerg Med. 2011;40:598–604.CrossRefPubMedGoogle Scholar
  19. 19.
    Pasquier M, Carron PN, Vallotton L, Yersin B. Electronic control device exposure: a review of morbidity and mortality. Ann Emerg Med. 2011;58:178–88.CrossRefPubMedGoogle Scholar
  20. 20.
    Ho JD, Dawes DM, Reardon RF, Strote SR, Kunz SN, Nelson RS, et al. Human cardiovascular effects of a new generation conducted electrical weapon. Forensic Sci Int. 2011;204:50–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Dawes DM, Ho JD, Sweeney JD, Lundin EJ, Kunz SN, Miner JR. The effect of an electronic control device on muscle injury as determined by creatine kinase enzyme. Forensic Sci Med Pathol. 2011;7:3–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Ho JD, Dawes DM, Nelson RS, Lundin EJ, Ryan FJ, Overton KG, et al. Acidosis and catecholamine evaluation following simulated law enforcement "use of force" encounters. Acad Emerg Med. 2010;17:e60–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Dawes DM, Ho JD, Reardon RF, Miner JR. The cardiovascular, respiratory, and metabolic effects of a long duration electronic control device exposure in human volunteers. Forensic Sci Med Pathol. 2010;6:268–74.CrossRefPubMedGoogle Scholar
  24. 24.
    Ho JD, Dawes DM, Cole JB, Hottinger JC, Overton KG, Miner JR. Lactate and pH evaluation in exhausted humans with prolonged TASER X26 exposure or continued exertion. Forensic Sci Int. 2009;190:80–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Bozeman WP, Hauda WE 2nd, Heck JJ, Graham DD Jr, Martin BP, Winslow JE. Safety and injury profile of conducted electrical weapons used by law enforcement officers against criminal suspects. Ann Emerg Med. 2009;53:480–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Vilke GM, Sloane C, Levine S, Neuman T, Castillo E, Chan TC. Twelve-lead electrocardiogram monitoring of subjects before and after voluntary exposure to the Taser X26. Am J Emerg Med. 2008;26:1–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Sloane CM, Chan TC, Levine SD, Dunford JV, Neuman T, Vilke GM. Serum troponin I measurement of subjects exposed to the Taser X-26. J Emerg Med. 2008;35:29–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Dawes DM, Ho JD, Johnson MA, Lundin E, Janchar TA, Miner JR. 15-second conducted electrical weapon exposure does not cause core temperature elevation in non-environmentally stressed resting adults. Forensic Sci Int. 2008;176:253–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Vilke GM, Sloane CM, Bouton KD, Kolkhorst FW, Levine SD, Neuman TS, et al. Physiological effects of a conducted electrical weapon on human subjects. Ann Emerg Med. 2007;50:569–75.CrossRefPubMedGoogle Scholar
  30. 30.
    Dawes D, Ho J, Miner J. The neuroendocrine effects of the TASER X26: a brief report. Forensic Sci Int. 2009;183:14–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Dawes DM, Ho JD, Reardon RF, Strote SR, Nelson RS, Lundin EJ, et al. The respiratory, metabolic, and neuroendocrine effects of a new generation electronic control device. Forensic Sci Int. 2011;207:55–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Zimmer P, Stritt C, Bloch W, Schmidt FP, Hubner ST, Binnebossel S, et al. The effects of different aerobic exercise intensities on serum serotonin concentrations and their association with Stroop task performance: a randomized controlled trial. Eur J Appl Physiol. 2016;116:2025–34.CrossRefPubMedGoogle Scholar
  33. 33.
    Takeuchi A, Ahern TL, Henderson SO. Excited delirium. West J Emerg Med. 2011;12:77–83.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Vilke GM, DeBard ML, Chan TC, Ho JD, Dawes DM, Hall C, et al. Excited delirium syndrome (ExDS): defining based on a review of the literature. J Emerg Med. 2012;43:897–905.CrossRefPubMedGoogle Scholar
  35. 35.
    Vilke GM, Payne-James J, Karch SB. Excited delirium syndrome (ExDS): redefining an old diagnosis. J Forensic Legal Med. 2012;19:7–11.CrossRefGoogle Scholar
  36. 36.
    Gonin P, Beysard N, Yersin B, Carron PN. Excited delirium: a systematic review. Acad Emerg Med. 2018;25:552–65.CrossRefPubMedGoogle Scholar
  37. 37.
    Gill JR. The syndrome of excited delirium. Forensic Sci Med Pathol. 2014;10:223–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Plush T, Shakespeare W, Jacobs D, Ladi L, Sethi S, Gasperino J. Cocaine-induced agitated delirium: a case report and review. J Intensive Care Med. 2015;30:49–57.CrossRefPubMedGoogle Scholar
  39. 39.
    Kesha K, Boggs CL, Ripple MG, Allan CH, Levine B, Jufer-Phipps R, et al. Methylenedioxypyrovalerone ("bath salts"), related death: case report and review of the literature. J Forensic Sci. 2013;58:1654–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Ho JD, Smith SW, Nystrom PC, Dawes DM, Orozco BS, Cole JB, et al. Successful management of excited delirium syndrome with prehospital ketamine: two case examples. Prehosp Emerg Care. 2013;17:274–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Hall CA, Kader AS, Danielle McHale AM, Stewart L, Fick GH, Vilke GM. Frequency of signs of excited delirium syndrome in subjects undergoing police use of force: descriptive evaluation of a prospective, consecutive cohort. J Forensic Legal Med. 2013;20:102–7.CrossRefGoogle Scholar
  42. 42.
    Dean BV, Stellpflug SJ, Burnett AM, Engebretsen KM. 2C or not 2C: phenethylamine designer drug review. J Med Toxicol. 2013;9:172–8.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Penders TM, Gestring RE, Vilensky DA. Intoxication delirium following use of synthetic cathinone derivatives. Am J Drug Alcohol Abuse. 2012;38:616–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Murray BL, Murphy CM, Beuhler MC. Death following recreational use of designer drug "bath salts" containing 3,4-Methylenedioxypyrovalerone (MDPV). J Med Toxicol. 2012;8:69–75.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Johnson MM, David JA, Michelhaugh SK, Schmidt CJ, Bannon MJ. Increased heat shock protein 70 gene expression in the brains of cocaine-related fatalities may be reflective of postdrug survival and intervention rather than excited delirium. J Forensic Sci. 2012;57:1519–23.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Otahbachi M, Cevik C, Bagdure S, Nugent K. Excited delirium, restraints, and unexpected death: a review of pathogenesis. Am J Forensic Med Pathol. 2010;31:107–12.CrossRefPubMedGoogle Scholar
  47. 47.
    Lucena J, Blanco M, Jurado C, Rico A, Salguero M, Vazquez R, et al. Cocaine-related sudden death: a prospective investigation in south-west Spain. Eur Heart J. 2010;31:318–29.CrossRefPubMedGoogle Scholar
  48. 48.
    Samuel E, Williams RB, Ferrell RB. Excited delirium: consideration of selected medical and psychiatric issues. Neuropsychiatr Dis Treat. 2009;5:61–6.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Paterson S, Cordero R, Stearns E. Chronic drug use confirmed by hair analysis: its role in understanding both the medical cause of death and the circumstances surrounding the death. J Forensic Legal Med. 2009;16:143–7.CrossRefGoogle Scholar
  50. 50.
    Ho JD, Dawes DM, Nystrom PC, Collins DP, Nelson RS, Moore JC, et al. Markers of acidosis and stress in a sprint versus a conducted electrical weapon. Forensic Sci Int. 2013;233:84–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Ho JD, Dawes DM, Bultman LL, Moscati RM, Janchar TA, Miner JR. Prolonged TASER use on exhausted humans does not worsen markers of acidosis. Am J Emerg Med. 2009;27:413–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Dawes D, Kroll M. Neuroendocrine effects of CEWs. In: Kroll M, Ho J, editors. TASER conducted electrical weapons: physiology, pathology, and law. New York City: Springer-Kluwer; 2009.Google Scholar
  53. 53.
    Kunz SN, Grove N, Fischer F. Acute pathophysiological influences of conducted electrical weapons in humans: a review of current literature. Forensic Sci Int. 2012;221:1–4.CrossRefPubMedGoogle Scholar
  54. 54.
    Mash DC, Staley JK, Izenwasser S, Basile M, Ruttenber AJ. Serotonin transporters upregulate with chronic cocaine use. J Chem Neuroanat. 2000;20:271–80.CrossRefPubMedGoogle Scholar
  55. 55.
    Pitts DK, Marwah J. Cocaine modulation of central monoaminergic neurotransmission. Pharmacol Biochem Behav. 1987;26:453–61.CrossRefPubMedGoogle Scholar
  56. 56.
    Labotz M, Wolff TK, Nakasone KT, Kimura IF, Hetzler RK, Nichols AW. Selective serotonin reuptake inhibitors and rhabdomyolysis after eccentric exercise. Med Sci Sports Exerc. 2006;38:1539–42.CrossRefPubMedGoogle Scholar
  57. 57.
    Vilke GM, Payne-James JJ. Excited delirium syndrome aetiology, identification and treatment. Current practice in forensic medicine. 2016;2:97–117.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisUSA
  2. 2.California Polytechnic UniversitySan Luis ObispoUSA
  3. 3.Emergency Medicine and Medical ToxicologyUniversity of Texas Southwestern Medical CenterDallasUSA
  4. 4.Lakewood Health SystemsStaplesUSA
  5. 5.Suffolk CountyUSA
  6. 6.Department of Biomedical EngineeringTexas A&M UniversityCollege StationUSA

Personalised recommendations