Antipsychotics for preventing and treating delirium: not recommended

Delirium is a common and debilitating condition that causes disturbances in attention and cognition. Its onset is often rapid and is associated with more extended hospital stays, complications and poorer outcomes. The elderly are at particular risk; they are more sensitive to changes in their baseline physiology, and delirium is easily misdiagnosed due to clinical similarities with dementia and psychosis.1 Guidelines have emphasised the importance of non-pharmacological management, but the publication of two recent systematic reviews provides essential evidence on the role of drug therapy. The first review evaluated antipsychotics for prevention of delirium in adults. They found 14 randomised controlled trials (n=4281) done in inpatients that reported no differences between haloperidol and placebo in the incidence or duration of delirium, length of hospital stay or mortality when used for …