{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:06:44Z","timestamp":1755216404251,"version":"3.43.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psychiatry Clin Neurosci"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Numerous network meta\u2010analyses (NMAs) have reported inconsistent findings on the efficacy of various pharmacologic treatments for delirium prevention in high\u2010risk patients. A potential confounder was the study design\u2014using a placebo control or standard\u2010of\u2010care (SoC) control. We reexamined the incident delirium between SoC plus placebo and SoC alone in randomized controlled trials (RCTs) on delirium prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We systematically searched for relevant RCTs on pharmacotherapies for delirium prevention from the inception of electronic databases through 30 November 2023. The primary outcome was delirium incidence, with secondary consideration given to all\u2010cause mortality. We conducted a frequentist NMA using risk ratios (RRs) with 95% confidence intervals (CIs) as the effect size.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The NMA results from 86 RCTs (19,889 participants, with a mean age of 68.5\u2009years, and a mean female proportion of 44.0%) revealed that SoC plus placebo was associated with a lower risk of incident delirium than SoC alone (RR, 0.60 [95% CI, 0.41\u20130.88]). The RR of all\u2010cause mortality was not significant between these two study designs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found placebo effects on the incidence of delirium in RCTs involving high\u2010risk patients. Further RCTs should consider a three\u2010arm, parallel design including both a placebo group and an SoC group to replicate our study findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>CRD42023488481.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pcn.13850","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T08:58:31Z","timestamp":1750237111000},"page":"481-487","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Potential placebo bias in current trials of delirium prevention: a network meta\u2010analysis of 86 randomized controlled trials"],"prefix":"10.1111","volume":"79","author":[{"given":"Bing\u2010Yan","family":"Zeng","sequence":"first","affiliation":[{"name":"Institute of Biomedical Sciences National Sun Yat\u2010sen University  Kaohsiung Taiwan"},{"name":"Department of Internal Medicine E\u2010Da Dachang Hospital, I\u2010Shou University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1138-5586","authenticated-orcid":false,"given":"Chih\u2010Sung","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Beitou Branch, Tri\u2010Service General Hospital; School of Medicine National Defense Medical Center  Taipei Taiwan"},{"name":"Department of Psychiatry National Defense Medical Center  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8650-4060","authenticated-orcid":false,"given":"Chih\u2010Wei","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Te","family":"Lei","sequence":"additional","affiliation":[{"name":"Section of Immunology, Rheumatology, and Allergy Department of Pediatrics Hsinchu Munipical MacKay Children\u2019s Hospital  Hsinchu Taiwan"},{"name":"Center for Molecular and Clinical Immunology Chang Gung University  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevor","family":"Thompson","sequence":"additional","affiliation":[{"name":"Centre for Chronic Illness and Ageing University of Greenwich  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yen\u2010Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Prospect Clinic for Otorhinolaryngology &amp; 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