Do Neuroleptics Still Have a Role in Patients With Delirium?
Authors: Astrid Grouls, Eduardo Bruera, David Hui
Journal: Annals of Internal Medicine (2020)

Letters18 February 2020Do Neuroleptics Still Have a Role in Patients With Delirium?Astrid Grouls, MD, Eduardo Bruera, MD, and David Hui, MD, MScAstrid Grouls, MDUniversity of Texas M.D. Anderson Cancer Center, Houston, Texas (A.G., E.B., D.H.), Eduardo Bruera, MDUniversity of Texas M.D. Anderson Cancer Center, Houston, Texas (A.G., E.B., D.H.), and David Hui, MD, MScUniversity of Texas M.D. Anderson Cancer Center, Houston, Texas (A.G., E.B., D.H.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0702 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:There is much confusion about the use of neuroleptics in delirium. The systematic review by Nikooie and colleagues (1) is timely; however, we would like to express several concerns regarding methodological limitations.First, a systematic review can only draw conclusions based on the included studies. Existing randomized trials often suffer from small sample sizes, heterogeneous populations, and low medication doses. Delirium severity as an outcome is based on a composite of delirium symptoms that may obscure any treatment-related signals on individual items. Specifically, none of the clinical trials included in Nikooie and colleagues' systematic review focused the ...References1. Nikooie R, Neufeld KJ, Oh ES, et al. Antipsychotics for treating delirium in hospitalized adults: a systematic review. Ann Intern Med. 2019;171:485-95. [PMID: 31476770]. doi:10.7326/M19-1860 LinkGoogle Scholar2. Hui D, Frisbee-Hume S, Wilson A, et al. Effect of lorazepam with haloperidol vs haloperidol alone on agitated delirium in patients with advanced cancer receiving palliative care: a randomized clinical trial. JAMA. 2017;318:1047-1056. [PMID: 28975307] doi:10.1001/jama.2017.11468 CrossrefMedlineGoogle Scholar3. Barnard ND, Willett WC, Ding EL. The misuse of meta-analysis in nutrition research. JAMA. 2017;318:1435-1436. [PMID: 28975260] doi:10.1001/jama.2017.12083 CrossrefMedlineGoogle Scholar4. Maskery SM, Zhang Y, Jordan RM, et al. Co-occurrence analysis for discovery of novel breast cancer pathology patterns. IEEE Trans Inf Technol Biomed. 2006;10:497-503. [PMID: 16871717] CrossrefMedlineGoogle Scholar5. Bruera E, Bush SH, Willey J, et al. Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer. 2009;115:2004-12. [PMID: 19241420] doi:10.1002/cncr.24215 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Texas M.D. Anderson Cancer Center, Houston, Texas (A.G., E.B., D.H.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0702. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAntipsychotics for Treating Delirium in Hospitalized Adults Roozbeh Nikooie , Karin J. Neufeld , Esther S. Oh , Lisa M. Wilson , Allen Zhang , Karen A. Robinson , and Dale M. Needham Do Neuroleptics Still Have a Role in Patients With Delirium? Roozbeh Nikooie , Esther S. Oh , Allen Zhang , Karen A. Robinson , and Dale M. Needham Metrics Cited byCurrent practice of pharmacological treatment for hyperactive delirium in terminally ill cancer patients: results of a nationwide survey of Japanese palliative care physicians and liaison psychiatristsNeuroleptic strategies for terminal agitation in patients with cancer and delirium at an acute palliative care unit: a single-centre, double-blind, parallel-group, randomised trial 18 February 2020Volume 172, Issue 4Page: 295KeywordsAntipsychoticsCritical careDeliriumDisclosurePalliative carePopulation statisticsRandomized trialsSedationSleepSystematic reviews ePublished: 18 February 2020 Issue Published: 18 February 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...