Restraint-related asphyxia on the basis of a drug-induced excited delirium

Cases of intoxication in combination with extreme agitation, physical exertion and restraint are mainly associated with restraint-related deaths (RRD) in the context of police use of force. In these cases, the mechanism of death usually mentioned is RRD associated with drug-induced excited delirium. To the best of our knowledge, there are no cases published on RRD that occurred during a physical encounter among civilians. We present a case of a 39-year old man, who died during a struggle with another person while being chokehold in a prone position with a knee on his back. Detailed witness testimonies as well as reliable blood parameters, which were taken immediately after his death, helped to define a most probable diagnosis. The deceased suffered from schizophrenia, consumed amphetamine and bupropion. He showed typical symptoms of an agitated delirious state, most likely induced by bupropion intoxication. The cause of death was restraint asphyxia by a second party on the basis of an excited delirium. The manner of death was concluded to be manslaughter.