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General medicine
Antipsychotics for preventing and treating delirium: not recommended
  1. Carl Heneghan1,
  2. Jack O'Sullivan2
  1. 1 Centre for Evidence-Based Medicine, Nuffield Dept of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 School of Medicine, Stanford University, Stanford, California, USA
  1. Correspondence to Professor Carl Heneghan, Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK; carl.heneghan{at}

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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 …

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  • Twitter @carlheneghan, @@DrJackOSullivan

  • Contributors CH drafted the first version and JO'S contributed to the revisions. Both authors approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CH is supported by the NIHR School for Primary Care ResearchEvidence Synthesis Working group (NIHR SPCR ESWG project 390, the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, an NIHR Senior Investigator and Editor in Chief of BMJ Evidence-Based Medicine. JO'S is supported by an NIH postdoctoral research at Stanford University. He is an associate editor at BMJ EBM.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.