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February 27, 2019

Pharmacologic Intervention for the Treatment and Prevention of Delirium: Looking Beneath the Modeling

Author Affiliations
  • 1Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina
JAMA Psychiatry. 2019;76(5):472-473. doi:10.1001/jamapsychiatry.2018.4276

Delirium is among the most prevalent and difficult psychiatric problems encountered in hospitals and other medical institutions. Pharmacologic treatment has been a mainstay among treatment options despite evidence that medications, specifically antipsychotics, have not been proven effective for the treatment or prevention of delirium.1,2 In the study by Wu and colleagues3 in this issue of JAMA Psychiatry, the authors use a variant of meta-analysis (network meta-analysis [NMA]) to explore pharmacologic interventions for delirium. The objective of the analyses was to ascertain if new agents or combinations of existing agents currently available can be substantiated as superior to placebo or widely used medications (eg, haloperidol) for the treatment and prevention of delirium. The authors perform an extensive review of the extant literature of well-designed and controlled clinical trials. Fifty-eight randomized clinical trials (RCTs) were included in the analyses, of which 20 RCTs with a total of 1435 participants compared the outcomes of treatment of delirium and 38 RCTs with a total of 8168 participants examined prevention.