New RCT suggests non-drug alternatives are needed | The Mental Elf
A recent meta-analysis of antipsychotics for delirium (Kishi et al, 2016) included trials comparing antipsychotics to usual care and placebo amongst a variety of settings, not specifically palliative care. There was similar size in effectiveness of antipsychotics compared to both placebo and usual care for response rates at study endpoint (with a very good Number Needed to Treat of 2) but only 1 placebo controlled study. There was no difference between antipsychotics and placebo on severity of delirium in the 1 study that measured this; there was a large effect size advantage for antipsychotics compared to usual care, but the placebo comparison is more relevant. There was a non-significant advantage for haloperidol compared to newer antipsychotics for rate of response, but a significant advantage for newer antipsychotics to reduce time to response. Antipsychotics were associated with a higher rate of side-effects.
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