Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists
Abstract
:1. Introduction
2. Methods
2.1. Studied Group and Procedure
2.2. Statistical Analysis
3. Results
3.1. Characteristics of the Studied Group of Psychiatrists
3.2. Definition of Polypharmacotherapy
3.3. Reasons for Using Polypharmacotherapy
3.4. Type of Polypharmacotherapy
3.5. Clozapine Pharmacotherapy in the Treatment of Schizophrenia
3.6. Polypharmacotherapy in the Treatment of Bipolar Disorder
3.7. Hepatotoxicity and the Effects of Psychiatric Drugs on Liver Function
3.8. Prevent and/or Reduce Excessive Polypharmacotherapy in Psychiatric Patients
- −
- Asia, U = 4493; p < 0.001
- −
- Europe, U = 13,256; p < 0.001
- −
- North America, U = 4668.5; p < 0.001
- −
- South America, U = 11,697.5; p < 0.001
3.9. Possible Risks/Benefits Associated with the Use of Polypharmacotherapy
3.10. The Factors Influencing the Occurrence of the Phenomenon of Polypharmacotherapy
4. Discussion
5. Conclusions
6. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Questionnaire
- a.
- A patient taking two or more drugs simultaneously to treat a disease or disorder
- b.
- A patient taking two or more drugs from the same category simultaneously to treat a disease or disorder
- c.
- A patient taking two or more drugs from different categories simultaneously to treat a disease or disorder
- d.
- A patient taking two or more drugs to treat a disease or disorder for a period sufficient for the effects of these drugs to overlap
- e.
- A patient taking two or more drugs from any drug groups, including drugs unrelated to the therapy of the disease or disorder (such as NSAIDs).
- a.
- Monotherapy for a given disease does not bring the expected results according to clinical trials:
- b.
- Monotherapy for a given disease does not bring the expected results in the history of a given patient:
- c.
- Polypharmacotherapy was successful in other patients with similar symptoms or disorders:
- d.
- The high complexity of the disorder or its severe course makes it difficult to select an appropriate monotherapy:
- e.
- The use of combined drugs gives a better therapeutic effect than the use of one drug in other patients with a similar disorder/symptoms:
- a.
- Two or more antidepressant drugs
- b.
- Two or more antipsychotic drugs
- c.
- Antidepressants with sedative–hypnotic drugs
- d.
- Antidepressants with antipsychotics
- e.
- Antipsychotics with sedative–hypnotic drugs
- a.
- The use of clozapine monotherapy may be associated with a reduced need for hospitalisation than in the case of antipsychotic polypharmacy in the treatment of schizophrenia.
- b.
- Polypharmacotherapy with sulpiride and clozapine does not show increased efficacy compared to clozapine monotherapy in the treatment of schizophrenia in patients who are refractory to treatment with atypical antipsychotics.
- c.
- Clozapine is a drug which can cause severe liver damage when used in monotherapy.
- d.
- Liver enzymes should be monitored during high-dose clozapine therapy to avoid potential hepatotoxic side-effects.
- e.
- Clozapine monotherapy has no confirmed and described hepatotoxic side-effects.
- a.
- In the treatment of depression symptoms in BD, the addition of lamotrigine to quetiapine does not increase the efficacy of the pharmacotherapy.
- b.
- The addition of lamotrigine when using quetiapine reverses the pro-inflammatory effects of quetiapine in microglia cells.
- c.
- Patients undergoing monotherapy for the treatment of BD more often have relapses of acute manic episodes than patients undergoing polypharmacotherapy.
- d.
- Women with BD during pregnancy and in the puerperium period should undergo prophylactic polypharmacotherapy in order to avoid episodes of the disease during this period.
- e.
- In depressive states in BD, it is permissible to combine two or even three drugs which have different mechanisms of action or those that have a synergistic effect.
- a.
- Knowledge of the effects of drugs on liver function is useful when planning therapy for psychiatric patients taking more than one drug.
- b.
- Hepatotoxicity is a well-studied and reported side-effect of many drugs used in psychiatric practice.
- c.
- Drug-related hepatotoxicity can be unequivocally determined when the symptoms of liver damage occur after a patient starts taking a drug, and disappear when the drug is discontinued.
- d.
- Drug-related hepatotoxicity can be unequivocally determined when the symptoms of liver damage occur after a patient starts taking a drug, disappear when the drug is discontinued, and reappear after the next administration of the same drug.
- e.
- When prescribing drugs, in particular, potentially hepatotoxic drugs, the patient should be required to test and monitor the level of liver enzymes.
- f.
- Minimising polypharmacotherapy, in particular, with potentially hepatotoxic drugs, may lower the risk of liver damage in psychiatric patients.
- a.
- Education and training of hospital staff (doctors, nurses):
- b.
- Conducting internal audits and controls:
- c.
- Educating patients and improving their understanding of the disease, the drug used, and its side-effects:
- d.
- Collaborating with specialists in the field of pharmacology or with pharmacists to review the list of drugs taken by patients in polypharmacotherapy:
- e.
- Introducing new programmes or applications into medical practice to help doctors show the medications taken previously by patients and their effectiveness:
- a.
- For some patients treated with antipsychotics, the therapeutic effect of polypharmacotherapy is better than in the case of monotherapy, in particular, for clozapine therapy.
- b.
- Polypharmacotherapy may lead to prescribing too high doses of drugs.
- c.
- The introduction of a second drug may lead to a reduction in the occurrence of the negative side-effects of the first drug, including weight gain during psychiatric therapy, while maintaining the therapeutic effect.
- d.
- By ensuring faster and better therapeutic effects, polypharmacotherapy leads to better patient compliance with the doctor’s recommendations.
- e.
- Polypharmacotherapy is associated with reduced patient compliance with taking medications due to the increased complexity of the therapy.
- f.
- Thanks to better therapeutic effectiveness, polypharmacotherapy leads to lower therapy costs and less frequent medical consultations/hospitalisation.
- g.
- Polypharmacotherapy may be associated with a higher rate of hospitalisation.
- a.
- Demographic factors (age, gender, race, patient’s level of education)
- b.
- Personality disorders
- c.
- The presence of comorbidities
- d.
- The severity of the disease
- e.
- Resistance to treatment
- f.
- Socio-economic status
- g.
- Substance abuse
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Variable | n | % | Statistical Test Result * | |
---|---|---|---|---|
Continent | Asia | 261 | 19.6 | χ2(5) = 376.22; p < 0.001 |
Europe | 425 | 31.8 | ||
Australia | 86 | 6.4 | ||
Africa | 86 | 6.4 | ||
North America | 280 | 21 | ||
South America | 197 | 14.8 | ||
Sex | Male | 895 | 67 | χ2(1) = 155.08; p < 0.001 |
Female | 440 | 33 | ||
Age (years) | <40 | 774 | 58 | χ2(2) = 629.16; p < 0.001 |
41–60 | 523 | 39.2 | ||
61–80 | 38 | 2.8 | ||
Seniority (years) | 1–10 | 894 | 67 | χ2(3) = 1343.13; p < 0.001 |
11–20 | 269 | 20.1 | ||
21–30 | 147 | 11 | ||
>30 | 25 | 1.9 |
Definition of Polypharmacotherapy | Asia | Europe | Australia | Africa | North America | South America | Statistical Test Result * | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | n | % | ||
A patient taking two or more drugs simultaneously to treat a disease or disorder | 76 | 29.1 | 125 | 29.4 | 23 | 26.7 | 34 | 39.5 | 66 | 23.6 | 49 | 24.9 | χ2(20) = 58.55; p < 0.001; Vcr = 0.21 | 373 | 27.9 |
A patient taking two or more drugs from the same category simultaneously to treat a disease or disorder | 40 | 15.3 | 27 | 6.4 | 7 | 8.1 | 12 | 14 | 21 | 7.5 | 13 | 6.6 | 120 | 9 | |
A patient taking two or more drugs from different categories simultaneously to treat a disease or disorder | 39 | 14.9 | 71 | 16.7 | 16 | 18.6 | 10 | 11.6 | 43 | 15.4 | 26 | 13.2 | 205 | 15.4 | |
A patient taking two or more drugs to treat a disease or disorder for a period sufficient for the effects of these drugs to overlap | 73 | 28 | 163 | 38.4 | 28 | 32.6 | 23 | 26.7 | 103 | 36.8 | 95 | 48.2 | 485 | 36.3 | |
A patient taking two or more drugs from any drug groups, including drugs unrelated to the therapy of the disease or disorder (such as NSAIDs) | 33 | 12.6 | 39 | 9.2 | 12 | 14 | 7 | 8.1 | 47 | 16.8 | 14 | 7.1 | 152 | 11.4 |
Reasons for Using Polypharmacotherapy (5—I Completely Agree, 3—It Is Difficult to Say, 1—I Do Not Agree at All) | Median | Statistical Test Result * | Overall | |||||
---|---|---|---|---|---|---|---|---|
Asia | Europe | Australia | Africa | North America | South America | |||
Monotherapy for a given disease does not bring the expected results according to clinical trials | 2 | 3 | 2 | 2 | 2 | 2 | H = 5.17; p = 0.4 | 2 |
Monotherapy for a given disease does not bring the expected results in the history of a given patient | 2 | 2 | 2 | 2 | 2 | 1 | H = 4.66; p = 0.46 | 2 |
Polypharmacotherapy was successful in other patients with similar symptoms or disorders | 2 | 3 | 2 | 2 | 3 | 2 | H = 3.13; p = 0.68 | 2 |
The high complexity of the disorder or its severe course makes it difficult to select an appropriate monotherapy | 4 | 4 | 3 | 3 | 4 | 4 | H = 6.03; p = 0.3 | 4 |
The use of combined drugs gives a better therapeutic effect than the use of one drug in other patients with a similar disorder/symptoms. | 2 | 2 | 1 | 1 | 2 | 1 | H = 10.29; p = 0.07 | 2 |
Type of Polypharmacotherapy | Asia | Europe | Australia | Africa | North America | South America | Statistical Test Result * | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | n | % | ||
Two or more antidepressant drugs | 78 | 29.9 | 137 | 32.2 | 22 | 25.6 | 23 | 26.7 | 78 | 27.9 | 52 | 26.4 | χ2(5) = 3,74; p = 0.59; Vcr = 0.05 | 390 | 29.2 |
Two or more antipsychotic drugs | 82 | 31.4 | 152 | 35.8 | 32 | 37.2 | 45 | 52.3 | 102 | 36.4 | 68 | 34.5 | χ2(5) = 12.6; p = 0.03; Vcr = 0.1 | 481 | 36 |
Antidepressants with sedative–hypnotic drugs | 127 | 48.7 | 199 | 46.8 | 37 | 43 | 31 | 36 | 124 | 44.3 | 113 | 57.4 | χ2(5) = 14.25; p = 0.01; Vcr = 0.1 | 631 | 47.3 |
Antidepressants with antipsychotics | 171 | 65.5 | 302 | 71.1 | 65 | 75.6 | 54 | 62.8 | 200 | 71.4 | 123 | 62.4 | χ2(5) = 10.14; p = 0.07; Vcr = 0.09 | 915 | 68.5 |
Antipsychotics with sedative–hypnotic drugs | 48 | 18.4 | 104 | 24.5 | 10 | 11.6 | 16 | 18.6 | 58 | 20.7 | 48 | 24.4 | χ2(5) = 10.21; p = 0.07; Vcr = 0.09 | 284 | 21.3 |
Clozapine Pharmacotherapy in the Treatment of Schizophrenia | Asia | Europe | Australia | Africa | North America | South America | Statistical Test Result * | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | n | % | ||
The use of clozapine monotherapy may be associated with a reduced need for hospitalisation than in the case of antipsychotic polypharmacotherapy in the treatment of schizophrenia. | 202 | 77.4 | 327 | 76.9 | 74 | 86 | 65 | 75.6 | 207 | 73.9 | 153 | 77.7 | χ2(5) = 5.64; p = 0.34; Vcr = 0.07 | 1028 | 77 |
Polypharmacotherapy with sulpiride and clozapine does not show increased efficacy compared to clozapine monotherapy in the treatment of schizophrenia in patients who are refractory to treatment with atypical antipsychotics. | 23 | 8.8 | 65 | 15.3 | 5 | 5.8 | 21 | 24.4 | 46 | 16.4 | 33 | 16.8 | χ2(5) = 20.78; p = 0.001; Vcr = 0.13 | 193 | 14.5 |
Clozapine is a drug which can cause severe liver damage when used in monotherapy. | 7 | 2.7 | 24 | 5.6 | 12 | 14 | 8 | 9.3 | 22 | 7.9 | 24 | 12.2 | χ2(5) = 23.24; p < 0.001; Vcr = 0.13 | 97 | 7.3 |
Liver enzymes should be monitored during high dose clozapine therapy to avoid potential hepatotoxic side-effects. | 78 | 29.9 | 104 | 24.5 | 38 | 44.2 | 25 | 29.1 | 90 | 32.1 | 87 | 44.2 | χ2(5) = 31.32; p < 0.001; Vcr = 0.15 | 422 | 31.6 |
Clozapine monotherapy has no confirmed and described hepatotoxic side-effects. | 46 | 17.6 | 69 | 16.2 | 25 | 29.1 | 8 | 9.3 | 33 | 11.8 | 54 | 27.4 | χ2(5) = 32.03; p < 0.001; Vcr = 0.16 | 235 | 17.6 |
Polypharmacotherapy in the Treatment of Bipolar Disorder | Asia | Europe | Australia | Africa | North America | South America | Statistical Test Result * | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | n | % | ||
In the treatment of depression symptoms in BD, the addition of lamotrigine to quetiapine does not increase the efficacy of the pharmacotherapy. | 8 | 3.1 | 12 | 2.8 | 7 | 8.1 | 11 | 12.8 | 17 | 6.1 | 25 | 12.7 | χ2(5) = 35; p < 0.001; Vcr = 0.16 | 80 | 6 |
The addition of lamotrigine when using quetiapine reverses the pro-inflammatory effects of quetiapine in microglia cells. | 6 | 2.3 | 6 | 1.4 | 5 | 5.8 | 7 | 8.1 | 11 | 3.9 | 21 | 10.7 | χ2(5) = 35; p = 0.001; Vcr = 0.16 | 56 | 4.2 |
Patients undergoing monotherapy for the treatment of BD more often have relapses of acute manic episodes than patients undergoing polypharmacotherapy. | 57 | 21.8 | 75 | 11.6 | 18 | 20.9 | 21 | 24.4 | 74 | 26.4 | 56 | 28.4 | χ2(5) = 12.53; p = 0.03; Vcr = 0.1 | 301 | 22.5 |
Women with BD during pregnancy and in the puerperium period should undergo prophylactic polypharmacotherapy in order to avoid episodes of the disease during this period. | 28 | 10.7 | 50 | 11.8 | 10 | 11.6 | 13 | 15.1 | 43 | 15.4 | 22 | 11.2 | χ2(5) = 3.98; p = 0.55; Vcr = 0.06 | 166 | 12.4 |
In depressive states in BD, it is permissible to combine two or even three drugs which have different mechanisms of action or those that have a synergistic effect. | 170 | 65.1 | 239 | 56.2 | 54 | 62.8 | 65 | 75.6 | 164 | 58.6 | 136 | 69 | χ2(5) = 19.38; p = 0.002; Vcr = 0.12 | 136 | 69 |
Hepatotoxicity and the Effects of Psychiatric Drugs on Liver Function | Asia | Europe | Australia | Africa | North America | South America | Statistical Test Result * | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | n | % | ||
Knowledge of the effects of drugs on liver function is useful when planning therapy for psychiatric patients taking more than one drug. | 219 | 83.9 | 411 | 96.7 | 77 | 89.5 | 69 | 80.2 | 244 | 87.1 | 184 | 93.4 | χ2(5) = 46.94; p < 0.001; Vcr = 0.19 | 1204 | 90.2 |
Hepatotoxicity is a well-studied and reported side-effect of many drugs used in psychiatric practice. | 119 | 45.6 | 139 | 32.7 | 17 | 19.8 | 8 | 9.3 | 83 | 29.6 | 50 | 25.4 | χ2(5) = 53.55; p < 0.001; Vcr = 0.2 | 416 | 31.2 |
Drug-related hepatotoxicity can be unequivocally determined when the symptoms of liver damage occur after a patient starts taking a drug, and disappear when the drug is discontinued. | 22 | 8.4 | 49 | 11.5 | 13 | 15.1 | 21 | 24.4 | 13 | 4.6 | 40 | 20.3 | χ2(5) = 44.3; p < 0.001; Vcr = 0.18 | 158 | 11.8 |
Drug-related hepatotoxicity can be unequivocally determined when the symptoms of liver damage occur after a patient starts taking a drug, disappear when the drug is discontinued, and reappear after the next administration of the same drug. | 187 | 71.6 | 267 | 62.8 | 50 | 58.1 | 59 | 68.6 | 173 | 61.8 | 129 | 65.5 | χ2(5) = 9.47; p = 0.09; Vcr = 0.08 | 865 | 64.8 |
When prescribing drugs, in particular, potentially hepatotoxic drugs, the patient should be required to test and monitor the level of liver enzymes. | 250 | 95.8 | 404 | 95.1 | 82 | 95.3 | 73 | 84.9 | 267 | 95.4 | 189 | 95.9 | χ2(5) = 18.32; p = 0.003; Vcr = 0.12 | 1265 | 94.8 |
Minimising polypharmacotherapy, in particular, with potentially hepatotoxic drugs, may lower the risk of liver damage in psychiatric patients. | 254 | 97.3 | 411 | 96.7 | 82 | 95.3 | 77 | 89.5 | 273 | 97.5 | 190 | 96.4 | χ2(5) = 13.7; p = 0.02; Vcr = 0.1 | 1287 | 96.4 |
Effectiveness of the Use the Following Methods to Prevent And/or Reduce Excessive Polypharmacotherapy in Psychiatric Patients (1–5 from Ineffective to Effective) | Median | Statistical Test Result * | Overall | |||||
---|---|---|---|---|---|---|---|---|
Asia | Europe | Australia | Africa | North America | South America | |||
Education and training of hospital staff (doctors, nurses) | 4 | 4 | 4 | 4 | 4 | 4 | H = 8.85; p = 0.12 | 4 |
Conducting internal audits and controls | 4 | 4 | 4 | 4 | 4 | 4 | H = 4.45; p = 0.49 | 4 |
Educating patients and improving their understanding of the disease, the drug used, and its side-effects | 4 | 4 | 4 | 4 | 4 | 4 | H = 3.05; p = 0.69 | 4 |
Collaborating with specialists in the field of pharmacology or with pharmacists to review the list of drugs taken by patients in polypharmacotherapy | 5 | 4 | 4 | 4 | 4 | 5 | H = 7.06; p = 0.22 | 4 |
Introducing new programmes or applications into medical practice to help doctors show the medications taken previously by patients and their effectiveness. | 4 | 4 | 4 | 4 | 5 | 4 | H = 5.93; p = 0.31 | 4 |
Risk/Benefits of Polypharmacotherapy | Asia | Europe | Australia | Africa | North America | South America | Statistical Test Result * | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | n | % | ||
For some patients treated with antipsychotics, the therapeutic effect of polypharmacotherapy is better than in the case of monotherapy, in particular, for clozapine therapy. | 52 | 19.9 | 79 | 18.6 | 14 | 16.3 | 18 | 20.9 | 56 | 20 | 30 | 15.2 | χ2(5) = 2.75; p = 0.74; Vcr = 0.05 | 249 | 18.7 |
Polypharmacotherapy may lead to prescribing too high doses of drugs. | 106 | 40.6 | 215 | 50.6 | 50 | 58.1 | 40 | 46.5 | 125 | 44.6 | 72 | 36.5 | χ2(5) = 18.97; p = 0.002; Vcr = 0.12 | 608 | 45.5 |
The introduction of a second drug may lead to a reduction in the occurrence of the negative side-effects of the first drug, including weight gain during psychiatric therapy, while maintaining the therapeutic effect. | 129 | 49.4 | 250 | 58.8 | 62 | 72.1 | 55 | 64 | 138 | 49.3 | 91 | 46.2 | χ2(5) = 28.26; p < 0.001; Vcr = 0.15 | 725 | 54.3 |
By ensuring faster and better therapeutic effects, polypharmacotherapy leads to better patient compliance with the doctor’s recommendations. | 26 | 10 | 39 | 9.2 | 6 | 7 | 9 | 10.5 | 31 | 11.1 | 40 | 20.3 | χ2(5) = 19.78; p = 0.001; Vcr = 0.12 | 151 | 11.3 |
Polypharmacotherapy is associated with reduced patient compliance with taking medications due to the increased complexity of the therapy. | 202 | 77.4 | 377 | 88.7 | 68 | 79.1 | 69 | 80.2 | 232 | 82.9 | 138 | 70.1 | χ2(5) = 35.21; p < 0.001; Vcr = 0.16 | 1086 | 81.3 |
Thanks to better therapeutic effectiveness, polypharmacotherapy leads to lower therapy costs and less frequent medical consultations/hospitalisation. | 10 | 3.8 | 10 | 2.4 | 5 | 5.8 | 9 | 10.5 | 16 | 5.7 | 18 | 9.1 | χ2(5) = 19.58; p = 0.002; Vcr = 0.12 | 68 | 5.1 |
Polypharmacotherapy may be associated with a higher rate of hospitalisation. | 42 | 16.1 | 72 | 16.9 | 18 | 20.9 | 20 | 23.3 | 47 | 16.8 | 34 | 17.3 | χ2(5) = 3.24; p = 0.66; Vcr = 0.05 | 233 | 17.5 |
Factor | Asia | Europe | Australia | Africa | North America | South America | Statistical Test Result * | Overall | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | n | % | ||
Demographic factors (age, gender, race, patient’s level of education) | 51 | 19.5 | 106 | 24.9 | 20 | 23.3 | 23 | 26.7 | 55 | 19.6 | 71 | 36 | χ2(5) = 21.62; p = 0.001; Vcr = 0.13 | 326 | 24.4 |
Personality disorders | 152 | 58.2 | 245 | 57.6 | 45 | 52.3 | 47 | 54.7 | 155 | 55.4 | 120 | 60.9 | χ2(5) = 2.71; p = 0.75; Vcr = 0.05 | 764 | 57.2 |
The presence of comorbidities | 208 | 79.7 | 385 | 90.6 | 68 | 79.1 | 70 | 81.4 | 249 | 88.9 | 182 | 92.4 | χ2(5) = 30.38; p < 0.001; Vcr = 0.15 | 1162 | 87 |
The severity of the disease | 230 | 88.1 | 397 | 93.4 | 77 | 89.5 | 73 | 84.9 | 259 | 92.5 | 185 | 93.9 | χ2(5) = 12.87; p = 0.03; Vcr = 0.1 | 1221 | 91.5 |
Resistance to treatment | 253 | 96.9 | 412 | 96.9 | 82 | 95.3 | 81 | 94.2 | 266 | 95 | 288 | 95.4 | χ2(5) = 3.32; p = 0.65; Vcr = 0.05 | 1282 | 96 |
Socio-economic status | 24 | 9.2 | 24 | 5.6 | 7 | 8.1 | 11 | 12.8 | 27 | 9.6 | 19 | 9.6 | χ2(5) = 7.53; p = 0.18; Vcr = 0.08 | 112 | 8.4 |
Substance abuse | 147 | 56.3 | 252 | 59.3 | 53 | 61.6 | 42 | 48.8 | 166 | 59.3 | 97 | 49.2 | χ2(5) = 9.43; p = 0.09; Vcr = 0.08 | 757 | 56.7 |
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Ordak, M.; Tkacz, D.; Golub, A.; Nasierowski, T.; Bujalska-Zadrozny, M. Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists. J. Clin. Med. 2022, 11, 2129. https://doi.org/10.3390/jcm11082129
Ordak M, Tkacz D, Golub A, Nasierowski T, Bujalska-Zadrozny M. Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists. Journal of Clinical Medicine. 2022; 11(8):2129. https://doi.org/10.3390/jcm11082129
Chicago/Turabian StyleOrdak, Michal, Daria Tkacz, Aniela Golub, Tadeusz Nasierowski, and Magdalena Bujalska-Zadrozny. 2022. "Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists" Journal of Clinical Medicine 11, no. 8: 2129. https://doi.org/10.3390/jcm11082129
APA StyleOrdak, M., Tkacz, D., Golub, A., Nasierowski, T., & Bujalska-Zadrozny, M. (2022). Polypharmacotherapy in Psychiatry: Global Insights from a Rapid Online Survey of Psychiatrists. Journal of Clinical Medicine, 11(8), 2129. https://doi.org/10.3390/jcm11082129