Placebo might be superior to antipsychotics in management of delirium in the palliative care setting.

Commentary on: Agar MR, Lawlor PG, Quinn S, et al . Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: a randomized clinical trial. JAMA Intern Med 2017;177:34–42. The need for controlled trials evaluating the efficacy of antipsychotics in the management of delirium has been recognised since the Practice Guidelines for the treatment of patients with delirium were introduced in 1999.1 Since then, only few relevant studies have been published. In contrast to the Practice Guidelines, which favoured psychopharmacological management, the National Institute for Health and Care Excellence Guidelines solely recommend psychopharmacological management for distress.2 To date, it has not yet been clearly defined what the distressing symptoms of delirium are. Considering this controversy and the necessity of further studies in this domain, the most beneficial approach for delirious patients remains unclear.3 4 In this multicentre, randomised clinical trial in the palliative care …