To the Editor We commend Agar et al1 for their excellent randomized clinical trial addressing the efficacy of antipsychotics for treating the symptoms of delirium in palliative care. It is, however, important to note that antipsychotic drugs are most effective in patients with delirium who are agitated. Because the patients in this study were having mild or moderate delirium, the conclusion that antipsychotic drugs should not be added to manage distressing symptoms of delirium may be an overstatement. Management of delirium in patients with advanced chronic illness, whether in the palliative care unit2 or other settings3,4 can be very challenging. Many patients present with severe agitation, and immediate and timely treatment is necessary; often, a parenteral route of treatment administration is required. For example, haloperidol and chlorpromazine were found to be superior to lorazepam in controlling delirium symptoms in patients with advanced AIDS.4 In refractory cases, palliative sedation is indicated.2
Elsayem AF, Fisch MJ. Neuroleptics for Delirium: More Research Is Needed. JAMA Intern Med. 2017;177(7):1053–1054. doi:10.1001/jamainternmed.2017.1789
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