The exact definition of this syndrome remains elusive, despite many publications apparently describing similar events (19,20). Indeed, the many different names given to these apparently similar conditions (Bell's mania, agitated delirium, excited delirium, and acute exhaustive mania) throughout the years indicate that it is a syndrome that may have many different facets, not all of which may be present in any single case. However, all of these descriptions do comment on the high potential for sudden collapse and death while the individual is in the highly excited states that they all describe. It is now accepted that such syndromes do exist, and although it is now commonly associated with use and abuse of cocaine (21), it is important to note that it was described in 1849 well before cocaine use and abuse became common (19).

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