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

Altunc A. T., BOYLU M. E., Uzum D., Kirbiyik F., TURAN Ş., POYRAZ B. Ç.

JOURNAL OF PSYCHOSOMATIC RESEARCH, vol.206, 2026 (SCI-Expanded, SSCI, Scopus) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 206
  • Publication Date: 2026
  • Doi Number: 10.1016/j.jpsychores.2026.112644
  • Journal Name: JOURNAL OF PSYCHOSOMATIC RESEARCH
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, BIOSIS, CINAHL, EMBASE, Gender Studies Database, MLA - Modern Language Association Database, Psycinfo
  • Istanbul University Affiliated: No

Abstract

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 (chi(2)(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 nonpharmacological strategies. Whether these trends translate into improved patient outcomes remains to be established and warrants prospective investigation.