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Comment & Response
July 2017

Neuroleptics for Delirium: More Research is Needed—Reply

Author Affiliations
  • 1Faculty of Health, University of Technology Sydney, New South Wales, Australia
  • 2Discipline, Palliative, and Supportive Services, Flinders University, South Australia, Australia
  • 3South West Sydney Clinical School, University of New South Wales, New South Wales, Australia
  • 4Ingham Institute of Applied Medical Research, New South Wales, Australia
  • 5School of Psychiatry, University of New South Wales, New South Wales, Australia
  • 6Department of Geriatric Medicine, Prince of Wales Hospital, New South Wales, Australia
  • 7Prince of Wales Clinical School, University of New South Wales, New South Wales, Australia
JAMA Intern Med. 2017;177(7):1055-1056. doi:10.1001/jamainternmed.2017.1801

In Reply Prior clinical trials of antipsychotics use delirium severity scores as a primary outcome. This is problematic because they include symptoms that are not treatment targets in clinical practice (ie, attention, orientation, memory); therefore, clinically meaningful differences for symptom relief are not established. In their Letters to the Editor, Elsayem and Fisch, as well as Bogman and Schieveld, suggest antipsychotic use to treat agitation, hallucinations, and delusions, but there is yet to be clinical trial evidence confirming this in any setting.1 In intensive care2 delirium-free or coma-free days have been used, but delirium resolution is often unachievable in palliative care.

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