A decade of change in delirium management: Temporal trends in psychotropic recommendations in a tertiary care hospital

Altunç A. T., BOYLU M. E., Üzüm D., Kırbıyık F., TURAN Ş., Poyraz B. Ç.

Journal of Psychosomatic Research, cilt.206, 2026 (SCI-Expanded, SSCI, Scopus) identifier identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 206
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1016/j.jpsychores.2026.112644
  • Dergi Adı: Journal of Psychosomatic Research
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, BIOSIS, CINAHL, EMBASE, Gender Studies Database, MLA - Modern Language Association Database, Psycinfo
  • Anahtar Kelimeler: Antipsychotics, Delirium, Geriatric psychiatry, Haloperidol, Psychotropic drugs, Recommendation trends
  • İstanbul Üniversitesi-Cerrahpaşa Adresli: Evet

Özet

Background Delirium is a common acute neuropsychiatric syndrome in hospitalized adults. Emerging evidence and updated guidelines increasingly discourage routine antipsychotic use in delirium due to safety concerns. This study examined temporal trends in psychotropic recommendations for delirium across two three-year epochs in a tertiary-care hospital. Methods This retrospective study analyzed 1812 psychiatric consultations for suspected delirium—of which 1657 were confirmed—comparing two epochs (2016–2019 vs. 2022–2025). Psychotropic recommendations, haloperidol administration routes, and clinical characteristics were compared between epochs. Binary logistic regression examined whether epoch-related differences persisted after adjustment for age, sex, and clinical setting. Results Mean age was significantly higher in epoch 2 (72.68 ± 14.28 vs. 70.15 ± 14.7 years, p < .001). Clinical setting distribution differed significantly between epochs, with surgical consultations declining (40.2% to 33.4%) and ICU consultations increasing (6.9% to 9.9%, p = .005). A significant shift in recommendation patterns was observed (χ2(7) = 245.57, p < .001): haloperidol and quetiapine decreased markedly, while olanzapine, melatonin, and non-pharmacological management only increased. Multi-agent recommendations declined from 17.9% to 6.3% ( p < .001). Intravenous haloperidol use fell sharply (61.5% to 16.6%, p < .001). After covariate adjustment, epoch remained an independent predictor of haloperidol (OR = 0.378), quetiapine (OR = 0.634), and non-pharmacological management only (OR = 3.051). Conclusion Delirium consultation practice has shifted toward more conservative, guideline-concordant recommendations, characterized by reduced haloperidol use, increased reliance on olanzapine, melatonin, and non-pharmacological strategies. Whether these trends translate into improved patient outcomes remains to be established and warrants prospective investigation.