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To the Editor: In their meta-analysis, Dr Schneider and colleagues¹ present evidence of a small but significant increase in the risk of death when antipsychotic drugs are used to treat neuropsychiatric symptoms in older adults with dementia. This risk develops quickly and is consistent across trials evaluating different antipsychotic agents. Antipsychotic drugs are used in a variety of treatment settings. For several reasons, the results of this meta-analysis may have implications for the safety of antipsychotic use in the setting of delirium treatment.

First, studies have linked delirium to an increased risk of mortality in older medical inpatients.² The risk of death develops quickly. How delirium promotes premature mortality remains unknown. Although it has generally been assumed that the underlying delirium triggers death, studies of this association have not adjusted for exposure to antipsychotic drugs. This omission may be due in part to the underrecognition of the potentially lethal adverse . . . [Full Text of this Article]

Sudeep S. Gill, MD, MSc
gills@pccchealth.org
Department of Medicine

Dallas Seitz, MD
Department of Psychiatry
Queen's University
Kingston, Ontario

Paula A. Rochon, MD, MPH
Institute for Clinical Evaluative Sciences
Toronto, Ontario

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