Razavi Journal of Medicine

Razavi Journal of Medicine

Changes in Delirium Rating Scale Scores Among ICU Patients with Delirium Receiving Haloperidol Versus Quetiapine: A Seven-Day Prospective Study

Articles in Press

Document Type : Original Article

Authors
Shahabaddin Sorouri 1
Amin Azimi Khorasani 2
Mona Kabiri 3
Elham Shaarbaf Eidgahi 4
1 Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Internal Medicine Residency, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
4 Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
10.30483/rjm.2026.254699.1484
Abstract
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.
Keywords
Haloperidol
Quetiapine
Delirium
ICU

Acknowledgements: Not applicable.


Availability of data and material: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Financial disclosure: Not applicable.


Conflicts of interests: The authors declared no conflict of interest.


Ethical Considerations: This study was conducted after obtaining an ethical code (IR.MUMS.IRH.REC.1402.096) from the Institutional Ethics Committee of Mashhad University of Medical Sciences. All research procedures were in accordance with the Helsinki Declaration.


Author contributions: Sh.S study design, A.A Kh Data acquisition, M.K data analysis, A.A Kh and M.K drafting, Sh.S critical reviewing, E.Sh data analysis, drafting.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 27 May 2026