{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:02:18Z","timestamp":1790359338519,"version":"4.1.0"},"reference-count":63,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite growing acceptance in some clinical settings, its risks necessitate caution due to adverse effects, drug interactions, and poor adherence. We aimed to find the prevalence, patterns, and predictors of psychiatric polypharmacy among adults at Sbrana Psychiatric Hospital (SPH) in Lobatse, Botswana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study involved the collection of demographic and clinical data via interviews and medical records from 300 participants at SPH, which were subsequently analyzed using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of participants was 36.5 years (SD 12.1), and they were predominantly male (55.3%). The overall prevalence of psychiatric polypharmacy was 49.7%, with the most prevalent subtype being multi-class polypharmacy (79.2%). Inpatients (Adjusted Odds Ratio [AOR] = 5.00; 95% Confidence Interval [CI]: 2.70,9.25), individuals with substance use disorder (AOR\u2009=\u20094.60; 95% CI: 1.18, 1.18,17.86), and those diagnosed with bipolar mood disorder (AOR\u2009=\u20092.67; 95% CI: 1.49,4.80) exhibited significant associations with psychiatric polypharmacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Psychiatric polypharmacy is common in this group, mostly due to bipolar disorder or substance use disorders. It is crucial to identify high-risk patients for reviews and to train clinicians in rational prescribing to improve medication use and minimize risks in Botswana.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359278","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:48:07Z","timestamp":1790358487000},"page":"e0359278","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychiatric polypharmacy in adult patients at the only referral psychiatric institute in Botswana: A cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8255-5778","authenticated-orcid":true,"given":"Boikhutso Changu","family":"Kinsman","sequence":"first","affiliation":[{"name":"University of Botswana","place":["Gaborone, Botswana"],"department":["Department of Psychiatry, Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6974-8015","authenticated-orcid":true,"given":"Hlanganiso","family":"Roy","sequence":"additional","affiliation":[{"name":"University of Botswana","place":["Gaborone, Botswana"],"department":["Department of Psychiatry, Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony A.","family":"Olashore","sequence":"additional","affiliation":[{"name":"University of Botswana","place":["Gaborone, Botswana"],"department":["Department of Psychiatry, Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"issue":"1","key":"pone.0359278.ref001","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1186\/s12888-022-04324-0","article-title":"Psychotropic medication use in people living with severe and persistent mental illness in the Australian community: A cross-sectional study","volume":"22","author":"J Hu","year":"2022","journal-title":"BMC Psychiatry"},{"issue":"2","key":"pone.0359278.ref002","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4103\/aip.aip_190_25","article-title":"Breaking down psychiatric polypharmacy: From evidence to practice","volume":"10","author":"K Ladi","year":"2025","journal-title":"Ann Indian Psychiatry"},{"issue":"1","key":"pone.0359278.ref003","doi-asserted-by":"crossref","first-page":"82","DOI":"10.4103\/0973-1229.104497","article-title":"Polypharmacy in psychiatry: A review","volume":"11","author":"S Kukreja","year":"2013","journal-title":"Mens Sana Monogr"},{"issue":"4","key":"pone.0359278.ref004","doi-asserted-by":"crossref","first-page":"958","DOI":"10.3390\/jcm13040958","article-title":"Mental health polypharmacy in \u201cNon-Coded\u201d primary care patients: The effect of deprescribing","volume":"13","author":"W Jerjes","year":"2024","journal-title":"J Clin Med"},{"issue":"4","key":"pone.0359278.ref005","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1177\/10783903231185353","article-title":"Psychiatric deprescribing: A narrative review","volume":"30","author":"SL Harding","year":"2024","journal-title":"J Am Psychiatr Nurses Assoc"},{"issue":"3","key":"pone.0359278.ref006","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/bcpt.13384","article-title":"Polypharmacy in schizophrenia","volume":"126","author":"L Baandrup","year":"2020","journal-title":"Basic Clin Pharmacol Toxicol"},{"issue":"2","key":"pone.0359278.ref007","first-page":"100","article-title":"The Dilemma of Polypharmacy in Psychiatry","volume":"26","author":"A Okasha","year":"2015","journal-title":"Arab J Psychiat"},{"issue":"3","key":"pone.0359278.ref008","article-title":"A Systematic review of complex polypharmacy in bipolar disorder: Prevalence, Clinical features, adherence, and preliminary recommendations for practitioners","volume":"82","author":"AM Kim","year":"2021","journal-title":"J Clin Psychiatry"},{"key":"pone.0359278.ref009","doi-asserted-by":"crossref","first-page":"92","DOI":"10.2174\/1745017901713010092","article-title":"Antipsychotic use pattern in schizophrenia outpatients: correlates of polypharmacy","volume":"13","author":"E Yazici","year":"2017","journal-title":"Clin Pract Epidemiol Ment Health"},{"issue":"2","key":"pone.0359278.ref010","doi-asserted-by":"crossref","first-page":"707","DOI":"10.3233\/JAD-160828","article-title":"Psychotropic polypharmacy in patients with Dementia: Prevalence and predictors","volume":"56","author":"A Norgaard","year":"2017","journal-title":"J Alzheimers Dis"},{"issue":"11","key":"pone.0359278.ref011","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1111\/jir.12775","article-title":"Polypharmacy and psychotropic polypharmacy in adults with intellectual disability: a cross-sectional total population study","volume":"64","author":"M McMahon","year":"2020","journal-title":"J Intellect Disabil Res"},{"issue":"1","key":"pone.0359278.ref012","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1186\/s12888-023-04860-3","article-title":"Management practice and discharge outcome of patients with psychiatric disorder admitted to psychiatry wards of selected specialized settings in Ethiopia","volume":"23","author":"MF Semman","year":"2023","journal-title":"BMC Psychiatry"},{"issue":"2","key":"pone.0359278.ref013","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e24243","article-title":"Prevalence and prescribers\u2019 knowledge of psychotropic polypharmacy in the Bono, Bono East, and Ahafo Regions, Ghana","volume":"10","author":"J Dumba","year":"2024","journal-title":"Heliyon"},{"issue":"2","key":"pone.0359278.ref014","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2478\/gp-2018-0006","article-title":"Pharmacotherapy prescribing patterns in the treatment of bipolar disorder in a South African outpatient population","volume":"1","author":"EM Holzapfel","year":"2018","journal-title":"Global Psychiatry"},{"key":"pone.0359278.ref015","doi-asserted-by":"crossref","first-page":"20451253211000610","DOI":"10.1177\/20451253211000610","article-title":"Defining polypharmacy: in search of a more comprehensive determination method applied in a tertiary psychiatric hospital","volume":"11","author":"J Govaerts","year":"2021","journal-title":"Ther Adv Psychopharmacol"},{"issue":"0","key":"pone.0359278.ref016","first-page":"1","article-title":"The frequency and factors associated with psychotropic polypharmacy among patients with psychiatric illness","author":"K S","year":"2024","journal-title":"Natl J Physiol Pharm Pharmacol"},{"issue":"1","key":"pone.0359278.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.59049\/2790-0231.1137","article-title":"Prevalence and factors associated with polypharmacy among patients treated for psychiatric disorders in Palestine","volume":"8","author":"S Hattab","year":"2023","journal-title":"Palestinian Medical and Pharmaceutical Journal"},{"issue":"4","key":"pone.0359278.ref018","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1002\/npr2.12467","article-title":"Prevalence of polypharmacy and factors impacting psychotropic prescribing patterns in women of childbearing potential at inpatient mental health services in Qatar","volume":"44","author":"N Elbakary","year":"2024","journal-title":"Neuropsychopharmacol Rep"},{"key":"pone.0359278.ref019","unstructured":"Khodaei MR, Mirabzadeh A, Shemshadi H, Ashtari Z, Ranjbar M, Faizzadeh G. Pattern of psychotropic drug prescription in the elderly with chronic schizophrenia. 2013."},{"issue":"3","key":"pone.0359278.ref020","doi-asserted-by":"crossref","first-page":"82","DOI":"10.31083\/ph.2024.3663","article-title":"Antidepressant prescription patterns and polypharmacy in outpatient psychiatry: A cross-sectional study","volume":"79","author":"MSR Al Zaabi","year":"2024","journal-title":"Pharmazie"},{"issue":"4","key":"pone.0359278.ref021","first-page":"215","article-title":"Polypharmacy in psychiatric out-patient practice in northern Nigeria","volume":"10","author":"AB Adeponle","year":"2007","journal-title":"Afr J Psychiatry (Johannesbg)"},{"key":"pone.0359278.ref022","first-page":"1","article-title":"Patterns of drug prescription in a psychiatric outpatient care unit\u2013the issue of polypharmacy","volume":"11","author":"BR Br\u00fcggemann","year":"2008","journal-title":"Ger J Psychiatry"},{"key":"pone.0359278.ref023","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.schres.2022.03.008","article-title":"The effect on relapse rate and psychiatric symptomatology: Switching a combination of first- and second-generation antipsychotic polypharmacy to antipsychotic monotherapy in long-term inpatients with schizophrenia and related disorders. A pragmatic randomized open-label trial (SwAP trial)","volume":"243","author":"M Shakir","year":"2022","journal-title":"Schizophr Res"},{"issue":"9","key":"pone.0359278.ref024","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1002\/pds.5310","article-title":"Polypharmacy and the risk of drug-drug interactions and potentially inappropriate medications in hospital psychiatry","volume":"30","author":"J Wolff","year":"2021","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"pone.0359278.ref025","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1471-244X-5-26","article-title":"Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics","volume":"5","author":"D Faries","year":"2005","journal-title":"BMC Psychiatry"},{"issue":"11","key":"pone.0359278.ref026","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s40265-021-01556-4","article-title":"Antipsychotic polypharmacy for the management of Schizophrenia: Evidence and recommendations","volume":"81","author":"M L\u00e4hteenvuo","year":"2021","journal-title":"Drugs"},{"issue":"1","key":"pone.0359278.ref027","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1001\/archgenpsychiatry.2009.175","article-title":"National trends in psychotropic medication polypharmacy in office-based psychiatry","volume":"67","author":"R Mojtabai","year":"2010","journal-title":"Arch Gen Psychiatry"},{"issue":"5","key":"pone.0359278.ref028","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2021.982","article-title":"Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics","volume":"7","author":"K Kaikoushi","year":"2021","journal-title":"BJPsych Open"},{"issue":"4","key":"pone.0359278.ref029","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1590\/1516-4446-2016-2015","article-title":"Prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in an upper-middle-income country","volume":"39","author":"KS Armstrong","year":"2017","journal-title":"Braz J Psychiatry"},{"issue":"9","key":"pone.0359278.ref030","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1176\/appi.ps.201800052","article-title":"Trends in and predictors of long-term antipsychotic polypharmacy use among Ohio Medicaid patients with schizophrenia, 2008-2014","volume":"69","author":"CA Fontanella","year":"2018","journal-title":"Psychiatr Serv"},{"issue":"2","key":"pone.0359278.ref031","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1176\/appi.ps.201700032","article-title":"Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disability","volume":"69","author":"Y Lunsky","year":"2018","journal-title":"Psychiatr Serv"},{"issue":"10","key":"pone.0359278.ref032","doi-asserted-by":"crossref","first-page":"3389","DOI":"10.3390\/jcm12103389","article-title":"Ten-year trends in psychotropic prescribing and polypharmacy in australian general practice patients with and without Dementia","volume":"12","author":"WM Bezabhe","year":"2023","journal-title":"J Clin Med"},{"key":"pone.0359278.ref033","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.schres.2016.04.010","article-title":"Predictors of long-term (\u22656months) antipsychotic polypharmacy prescribing in secondary mental healthcare","volume":"174","author":"G Kadra","year":"2016","journal-title":"Schizophr Res"},{"issue":"3","key":"pone.0359278.ref034","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.psc.2012.06.007","article-title":"Antipsychotic polypharmacy: a comprehensive evaluation of relevant correlates of a long-standing clinical practice","volume":"35","author":"CU Correll","year":"2012","journal-title":"Psychiatr Clin North Am"},{"key":"pone.0359278.ref035","doi-asserted-by":"crossref","first-page":"6191074","DOI":"10.1155\/2016\/6191074","article-title":"Prevalence of antipsychotic polypharmacy and associated factors among outpatients with schizophrenia attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia","volume":"2016","author":"S Tesfaye","year":"2016","journal-title":"Psychiatry J"},{"issue":"8","key":"pone.0359278.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0290037","article-title":"Antipsychotic polypharmacy and associated factors among patients with schizophrenia: Multicenter cross-sectional study in Northwest Ethiopia","volume":"18","author":"FB Tamene","year":"2023","journal-title":"PLoS One"},{"issue":"12","key":"pone.0359278.ref037","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1093\/ijnp\/pyab046","article-title":"Antipsychotic Polypharmacy Among Patients With Schizophrenia in Africa: A Systematic Review and Meta-Analysis","volume":"24","author":"W Ayenew","year":"2021","journal-title":"Int J Neuropsychopharmacol"},{"issue":"1","key":"pone.0359278.ref038","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1177\/1557988316630953","article-title":"Reviewing the Assumptions About Men\u2019s Mental Health: An Exploration of the Gender Binary","volume":"12","author":"DT Smith","year":"2018","journal-title":"Am J Mens Health"},{"key":"pone.0359278.ref039","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780198747437.001.0001","volume-title":"Shorter Oxford textbook of psychiatry","author":"PJ Harrison","year":"2017"},{"issue":"3","key":"pone.0359278.ref040","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4103\/jfcm.JFCM_31_19","article-title":"Correlates of psychotropic polypharmacy in outpatient psychiatric clinics of two military tertiary hospitals in Saudi Arabia","volume":"26","author":"FF Alharbi","year":"2019","journal-title":"J Family Community Med"},{"issue":"1","key":"pone.0359278.ref041","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/01.XME.0000438129.94669.1e","article-title":"The extent and correlates of same class versus multiclass polypharmacy among Egyptian psychiatric inpatients","volume":"21","author":"NM Shaker","year":"2014","journal-title":"Middle East Current Psychiatry"},{"issue":"9","key":"pone.0359278.ref042","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s40263-018-0542-4","article-title":"Association between psychotropic medication polypharmacy and an objective measure of balance impairment among middle-aged adults: Results from the US national health and nutrition examination survey","volume":"32","author":"N Bareis","year":"2018","journal-title":"CNS Drugs"},{"issue":"4","key":"pone.0359278.ref043","article-title":"Gender differences and psychotropic polypharmacy in psychiatric patients in Brazil: A cross-sectional analysis of the PESSOAS Project","volume":"33","author":"O Costa J de","year":"2017","journal-title":"Cad Saude Publica"},{"key":"pone.0359278.ref044","doi-asserted-by":"crossref","first-page":"1080073","DOI":"10.3389\/fphar.2023.1080073","article-title":"Psychiatric and non-psychiatric polypharmacy among older adults with schizophrenia: Trends from a population-based study between 2000 and 2016","volume":"14","author":"C Lunghi","year":"2023","journal-title":"Front Pharmacol"},{"issue":"4","key":"pone.0359278.ref045","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/JCP.0000000000001416","article-title":"Antipsychotic polypharmacy is associated with adverse drug events in psychiatric inpatients: The Japan adverse drug events study","volume":"41","author":"N Ayani","year":"2021","journal-title":"J Clin Psychopharmacol"},{"issue":"11","key":"pone.0359278.ref046","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1111\/bcp.13369","article-title":"Psychotropic polypharmacy in Australia, 2006 to 2015: a descriptive cohort study","volume":"83","author":"J Brett","year":"2017","journal-title":"Br J Clin Pharmacol"},{"key":"pone.0359278.ref047","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1471-244X-4-18","article-title":"Polypharmacy in psychiatric practice in the Canary Islands","volume":"4","author":"C De las Cuevas","year":"2004","journal-title":"BMC Psychiatry"},{"issue":"4","key":"pone.0359278.ref048","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s00406-021-01358-5","article-title":"Detailing the effects of polypharmacy in psychiatry: Longitudinal study of 320 patients hospitalized for depression or schizophrenia","volume":"272","author":"HH Stassen","year":"2022","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"pone.0359278.ref049","doi-asserted-by":"crossref","first-page":"3827","DOI":"10.2147\/NDT.S349127","article-title":"Adverse drug reaction and its predictors among psychiatric patients taking psychotropic medications at the Mizan-Tepi University Teaching Hospital","volume":"17","author":"F Ejeta","year":"2021","journal-title":"Neuropsychiatr Dis Treat"},{"issue":"3","key":"pone.0359278.ref050","doi-asserted-by":"crossref","first-page":"333","DOI":"10.4103\/psychiatry.IndianJPsychiatry_126_16","article-title":"A cross-sectional comparative study on the assessment of quality of life in psychiatric patients under remission treated with monotherapy and polypharmacy","volume":"59","author":"B Koshy","year":"2017","journal-title":"Indian J Psychiatry"},{"issue":"2","key":"pone.0359278.ref051","article-title":"Polypharmacy\u2013is it here to stay","volume":"6","author":"P Lodha","year":"2019","journal-title":"Indian J Mental Health"},{"issue":"2","key":"pone.0359278.ref052","doi-asserted-by":"crossref","first-page":"83","DOI":"10.35262\/jiag.v15i2.83-89","article-title":"Polypharmacy in elderly: Overview, prevalence and psychiatric perspectives","volume":"15","author":"P Sharma","year":"2019","journal-title":"Journal of the Indian Academy of Geriatrics"},{"key":"pone.0359278.ref053","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.3389\/fphar.2019.01659","article-title":"Psychotropic polypharmacy in adults 55 years or older: A risk for impaired global cognition, executive function, and mobility","volume":"10","author":"G Loggia","year":"2019","journal-title":"Front Pharmacol"},{"issue":"1","key":"pone.0359278.ref054","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12877-024-05584-z","article-title":"Polypharmacy and anticholinergic burden scales in older adults: a cross-sectional study among psychiatric outpatients in a tertiary care hospital","volume":"25","author":"M Bidarolli","year":"2025","journal-title":"BMC Geriatr"},{"issue":"2","key":"pone.0359278.ref055","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5644\/ama2006-124.198","article-title":"Assessment of inpatient psychiatric readmission risk among patients discharged on an antipsychotic polypharmacy regimen: A retrospective cohort study","volume":"46","author":"E Boskailo","year":"2017","journal-title":"Acta Med Acad"},{"issue":"4","key":"pone.0359278.ref056","doi-asserted-by":"crossref","first-page":"179","DOI":"10.15171\/ijhpm.2014.85","article-title":"Assessing performance of Botswana\u2019s public hospital system: the use of the world health organization health system performance assessment framework","volume":"3","author":"O Seitio-Kgokgwe","year":"2014","journal-title":"Int J Health Policy Manag"},{"issue":"1","key":"pone.0359278.ref057","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1186\/s12888-017-1347-6","article-title":"Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana","volume":"17","author":"AA Olashore","year":"2017","journal-title":"BMC Psychiatry"},{"issue":"3","key":"pone.0359278.ref058","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/JCP.0000000000001681","article-title":"Polypharmacy among patients with major depressive disorder and co-occurring substance use disorders in a psychiatric hospital setting: Prevalence and risk factors","volume":"43","author":"MB Benz","year":"2023","journal-title":"J Clin Psychopharmacol"},{"issue":"8","key":"pone.0359278.ref059","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1176\/appi.ps.201800504","article-title":"Association between antipsychotic polypharmacy and outcomes for people with serious mental illness in England","volume":"70","author":"P Kasteridis","year":"2019","journal-title":"Psychiatr Serv"},{"issue":"01","key":"pone.0359278.ref060","article-title":"Antipsychotic polypharmacy among psychiatric patients in hospital Kajang, Malaysia","volume":"06","author":"M FMS","year":"2018","journal-title":"J Neurol Disord"},{"key":"pone.0359278.ref061","first-page":"1","article-title":"Psychiatric polypharmacy, etiology and potential consequences","volume":"5","author":"S Sarkar","year":"2016","journal-title":"Current Psychopharmacol"},{"issue":"4","key":"pone.0359278.ref062","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/00912174231156027","article-title":"The prevalence of substance use disorders and associated characteristics among patients admitted to a psychiatric hospital in Botswana","volume":"58","author":"OE Otlhapile","year":"2023","journal-title":"Int J Psychiatry Med"},{"issue":"1","key":"pone.0359278.ref063","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12888-019-2056-0","article-title":"Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification","volume":"19","author":"J Carmona-Huerta","year":"2019","journal-title":"BMC Psychiatry"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359278","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:48:17Z","timestamp":1790358497000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359278"}},"subtitle":[],"editor":[{"given":"Jia-Lang","family":"Xu","sequence":"first","affiliation":[{"name":"National Taichung University of Science and Technology","place":["TAIWAN"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":63,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0359278","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]}}}