Antipsychotics to treat delirium among patients in the palliative phase?

This well-designed and carefully conducted study leads to the conclusion that there is no place for antipsychotics in the symptomatic treatment of delirium in the palliative phase of life. The study sample did not include a group of patients with severe delirium, so the results cannot be generalised to this category. Of course, further research into the treatment of delirium in the palliative phase, including antipsychotics, is still required, but it is clear that for the category of patients investigated in this study, treatment of their delirium with antipsychotics is not useful and may even worsen the symptoms. The elevated mortality risk due to the use of antipsychotics has been reported before in the context of its use in Alzheimer disease (Gebu 2009; 43: 32-33) as well as in treating behavioural problems in nursing homes (Gebu 2013; 47: 27-33).

The study discussed here contributes to the growing evidence that the balance of efficacy and side-effects of antipsychotics for the most common indications is negative.

  1. Diagnostic and Statistical Manual of Mental Disorders. DSM-5. Washington DC:
    American Psychiatric Association, 2014.
  2. Richtlijn Delier Volwassenen. Utrecht: Secretariaat NVKG, 2013.
  3. Lawlor PG, et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000; 160: 786-794.
  4. NHG-Standaard ’Delier’ [eerste herziening]. Huisarts Wet 2014; 57: 184-193.

*The literature refers to the Dutch text