Psychiatric polypharmacy in adult patients at the only referral psychiatric institute in Botswana: A cross-sectional study

Background 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. Methods 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. Results 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. Conclusions 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.