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To the Editor: In their article on delirium in the intensive care unit (ICU), Dr Ely and colleagues¹ recommended the use of haloperidol as a "procognitive" medication. Although conventional antipsychotic agents, such as haloperidol, have long been used to manage delirium, newer atypical antipsychotic agents may be a better choice, as they cause fewer extrapyramidal symptoms and may be more effective in improving cognition among patients with schizophrenia² and delirium.^3-5 Ely et al stated that pharmacological interventions in delirium involving medications such as haloperidol need to be tested in future research. However, it may be more important to conduct controlled, double-blind studies of second-generation antipsychotic agents, as these agents may be the preferred medication and are in common clinical use.

Financial Disclosure: Dr Frankenburg has been a coinvestigator in research studies funded by Eli Lilly and Co.

Frances R. Frankenburg, MD
Frances.Frankenburg@med.va.gov
Department of Inpatient Psychiatry
Edith Nourse Rogers Memorial Veterans Hospital
Bedford, Mass

1. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291:1753-1762. FREE FULL TEXT 2. Harvey PD, Green MF, Keefe RSE, Velligan DI. Cognitive functioning in schizophrenia: a consensus statement on its role in the definition and evaluation of effective treatments for the illness. J Clin Psychiatry. 2004;65:361-372. ISI | PUBMED 3. Breitbart W, Tremblay A, Gibson C. An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics. 2002;43:175-182. FREE FULL TEXT 4. Parellada E, Baeza I, de Pablo J, Martínez G. Risperidone in the treatment of patients with delirium. J Clin Psychiatry. 2004;65:348-353. PUBMED 5. Skrobik YK, Bergeron N, Dumont M, Gottfried SB. Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med. 2004;30:444-449. FULL TEXT | ISI | PUBMED

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;292:168.

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