This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Critical Care/ Intensive Care Medicine  • Psychiatry  • Delirium  • Adverse Effects  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: We agree with Dr Frankenburg that both typical and atypical/second generation antipsychotic agents should be studied in double-blind, controlled trials. While haloperidol is the current drug of choice for delirium, as we mentioned, neither this medication nor any other carries an indication from the US Food and Drug Administration for delirium. In fact, no placebo-controlled trials have documented that antipsychotic agents reduce the severity and duration of delirium, much less improve long-term clinical outcomes. Nevertheless, 70% of 912 clinicians reported in our recent survey that they use antipsychotic agents as their primary medical therapy for delirium in the ICU.¹

Considering the potential antipsychotic agent–related adverse effects of torsades de pointes, hypotension, neuroleptic malignant syndrome, and extrapyramidal symptoms, both the efficacy and safety of these agents must be evaluated in the context of future clinical trials. In the meantime, titrating sedative and analgesic medications to patient-specific, goal-directed target sedation . . . [Full Text of this Article]

E. Wesley Ely, MD, MPH
wes.ely@vanderbilt.edu

Robert S. Dittus, MD, MPH
Vanderbilt University School of Medicine
Nashville, Tenn