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.
Agar MR, Draper B, Caplan GA. Neuroleptics for Delirium: More Research is Needed—Reply. JAMA Intern Med. 2017;177(7):1055-1056. doi:10.1001/jamainternmed.2017.1801