Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X Articles in Press 2026 05 27 Changes in Delirium Rating Scale Scores Among ICU Patients with Delirium Receiving Haloperidol Versus Quetiapine: A Seven-Day Prospective Study 118632 10.30483/rjm.2026.254699.1484 EN Shahabaddin Sorouri Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Amin Azimi Khorasani Internal Medicine Residency, Mashhad University of Medical Sciences, Mashhad, Iran. Mona Kabiri Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran Elham Shaarbaf Eidgahi Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 0000-0003-2622-3627 Journal Article 2026 02 17 Background: Acute delirium is common in intensive care units (ICUs) and requires prompt intervention. Although haloperidol has been the first-line treatment, atypical antipsychotics such as quetiapine are increasingly considered due to potentially fewer side effects. Objectives: This study compared the efficacy and safety of quetiapine versus haloperidol for managing acute delirium in the ICU. Methods: This prospective cohort study enrolled patients with acute delirium in the ICU of Ghaem Hospital who had no contraindications to either drug. Patients were assigned to haloperidol or quetiapine based on standard care. Demographic data were recorded. Delirium severity was assessed daily for seven days using the Delirium Rating Scale-Revised-98 (DRS-R-98), and side effects were monitored. Data were analyzed using SPSS version 20. Results: A total of 76 patients were studied. The mean DRS-R-98 score on day 7 was significantly lower in the quetiapine group (26.58 ± 7.83) than in the haloperidol group (33.97 ± 6.36) (p < 0.001). The reduction in DRS score from baseline to day 7 was greater with quetiapine (−12.95 vs. −8.16, p < 0.001). Extrapyramidal side effects occurred exclusively in the haloperidol group. Hypersomnia was equally prevalent in both groups (36.8%). Delirium duration and other non-extrapyramidal side effects did not differ significantly between groups. Conclusion: Quetiapine was associated with a greater reduction in delirium severity and a more favorable extrapyramidal safety profile compared to haloperidol in this cohort. However, due to the non-randomized design and baseline imbalances, these findings should be considered hypothesis-generating. Large-scale, randomized studies are needed to definitively establish quetiapine’s efficacy in ICU delirium.

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