Published in PLOS One on 2026-09-25, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Boikhutso Changu Kinsman, Hlanganiso Roy, Anthony A. Olashore
Source: PLOS One • DOI 10.1371/journal.pone.0359278
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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.
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.
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 = 4.60; 95% CI: 1.18, 1.18,17.86), and those diagnosed with bipolar mood disorder (AOR = 2.67; 95% CI: 1.49,4.80) exhibited significant associations with psychiatric polypharmacy.
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.
Introduction
While not disregarding evidence supporting its use and its effectiveness in certain clinical scenarios, psychiatric polypharmacy remains an essential area of concern that merits focused attention, particularly considering its association with adverse outcomes that can adversely affect patients’ quality of life [1]. It involves the use of two or more psychotropics simultaneously to manage mental health conditions in a patient at the same time [2].
The prevalence of psychiatric polypharmacy has been estimated to range between 13% and 90% worldwide; the prevalence varies significantly across regions, specific psychiatric disorders, and all age groups [3–7]. A systematic review conducted among patients with bipolar mood disorder reported a psychiatric polypharmacy prevalence rate of 32.7% [8]. Among participants with a diagnosis of intellectual disability in the United Kingdom, one study found that 23% were on psychiatric polypharmacy, while two other studies conducted in Europe among patients with schizophrenia and dementia found prevalence rates of 71% and 25.3%, respectively [9–11]. Studies conducted in Africa have also reported significant prevalence rates of psychiatric polypharmacy of 83.45%, 66.0%, and 93.8% in Ethiopia, Ghana, and South Africa, respectively [12–14].
Studies have provided insights into the various types of psychiatric polypharmacy as classified by the National Association of State Mental Health Program Directors (NASMHPD). Previous research in South Asia, Europe, and West Asia identified multi-class polypharmacy as the most prevalent type [15–17]. Multi-class polypharmacy is when a patient is prescribed medications that belong to different classes to treat their symptoms [18,19]. On the contrary, a study conducted in Africa found that adjunctive polypharmacy, which involves the use of one medication to mitigate the side effects caused by another medication from a different class [20], was the most common type of psychiatric polypharmacy among participants [21]. Other types include same-class polypharmacy, which involves using multiple psychiatric medications that belong to the same class, and augmentation polypharmacy, which is the use of a medication at a lower-than-usual dose alongside another medication from a different class in full therapeutic doses to treat the same symptoms [3,19,21]. Augmentation polypharmacy can also mean prescribing a medication that would usually not be used alone to treat symptoms, for example, prescribing lithium to augment antidepressants [16]. When compared to the other types, same-class psychiatric polypharmacy is associated with increased risks of drug interactions and side effects [3,22,23].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Boikhutso Changu Kinsman, Hlanganiso Roy, Anthony A. Olashore. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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