Current Pharmaceutical DesignCurrent Pharmaceutical DesignCurrent Pharmaceutical Design1381-61281873-4286Bentham Science64578710.2174/0113816128297170240513105418Immunology, Inflammation & AllergyResearch ArticlePolypharmacy in Psychiatry: An In-depth Examination of Drug-drug Interactions and Treatment ChallengesShekhoDevankinfo@benthamscience.netMishraRitikainfo@benthamscience.netKamalRajinfo@benthamscience.netKhuranaDivyainfo@benthamscience.netChauhanAbhishekinfo@benthamscience.netAwasthiAnkitinfo@benthamscience.netDepartment of Pharmaceutics, ISF College of PharmacyDepartment of Quality Assurance, ISF College of Pharmacy0106202430211641164911012025Copyright ©; 2024, Bentham Science Publishers2024Bentham Science Publishershttps://journals.eco-vector.com/1381-6128/article/view/645787

Polypharmacy in psychiatry is an in-depth examination of drug-drug interactions and treatment challenges that explores the intricate landscape of psychiatric polypharmacy, a practice involving the prescription of multiple medications to individuals with mental health disorders. This review is based on the critical aspects of drug-drug interactions and the associated treatment challenges. Psychiatric polypharmacy is motivated by the complexity of mental health conditions, where monotherapy may be insufficient. While it offers potential benefits, the practice raises concerns related to drug interactions that can compromise safety and efficacy. The review delves into the prevalence and clinical indications for psychiatric polypharmacy, thoroughly analyzing drug interactions, treatment challenges, and strategies for mitigation. Real-world case studies illustrate the complexities and outcomes of managing complex medication regimens, while emerging trends in personalized medicine, advancements in psychopharmacology, multidisciplinary approaches, and digital health solutions offer a glimpse into the future of psychiatric polypharmacy. This examination underscores the importance of a patient-centered, evidence-based approach in optimizing psychiatric polypharmacy to achieve therapeutic benefits while minimizing risks.

Polypharmacypsychiatrydrug-drug interactionspharmacokineticpharmacodynamichealth disorders.Dumba J, Ibrahim M, Allotey S, Alorvi S, Appertey W. Prevalence and prescribers’ knowledge of psychotropic polypharmacy in the Bono, Bono East, and Ahafo Regions, Ghana. Heliyon 2023; 10(2): e24243.Howe J, Lindsey L. The role of pharmacists in supporting service users to optimise antipsychotic medication. Int J Clin Pharm 2023; 45(5): 1293-8. doi: 10.1007/s11096-023-01630-9 PMID: 37704913Patel S. Comorbidity and Polypharmacy: A Systematic Literature Review of Pharmacological Interventions for Pediatric ADHD and Associated Comorbidities. PhD thesis, The Chicago School of Professional Psychology 2023.Semman MF, Dadi FG, Ijigu GM, Moges BT, Tesfaye BT. Management practice and discharge outcome of patients with psychiatric disorder admitted to psychiatry wards of selected specialized settings in Ethiopia. BMC Psychiatry 2023; 23(1): 343. doi: 10.1186/s12888-023-04860-3 PMID: 37193987Paris J. Fads and fallacies in psychiatry. Cambridge University Press 2023. doi: 10.1017/9781009245746Mangin D, Lamarche L, Templeton JA, et al. Theoretical underpinnings of a model to reduce polypharmacy and its negative health effects: Introducing the Team Approach to Polypharmacy Evaluation and Reduction (TAPER). Drugs Aging 2023; 40(9): 857-68. doi: 10.1007/s40266-023-01055-z PMID: 37603255Bayona-Huguet X, Bayona-Pizarro M. Polypharmacy in home care. Intechopen. 2023.Contreras-Macías E, Gutiérrez-Pizarraya A, Morillo-Verdugo R. Influence of polypharmacy in the simultaneous presence of high pharmacotherapeutic complexity, drug interactions and non-adherence to medication in patients with HIV infection. Enferm Infecc Microbiol Clin 2023; 41(6): 342-7. doi: 10.1016/j.eimce.2022.09.007Farooq J, Sana MM, Chetana PM, et al. Polypharmacy in chronic liver disease patients: Implications for disease severity, drug-drug interaction, and quality of life. Saudi Pharm J 2023; 31(8): 101668. doi: 10.1016/j.jsps.2023.06.001 PMID: 37576859Falemban AH. Medication-related problems and their intervention in the geriatric population: A review of the literature. Cureus 2023; 15(9): e44594. doi: 10.7759/cureus.44594 PMID: 37795072Stuhec M, Hahn M, Taskova I, et al. Clinical pharmacy services in mental health in Europe: A commentary paper of the European Society of Clinical Pharmacy Special Interest Group on Mental Health. Int J Clin Pharm 2023; 45(5): 1286-92. doi: 10.1007/s11096-023-01643-4 PMID: 37755642Anil kumarYerragopu , Akki Rajesh , Rajesh A. Drug utilization study in the department of psychiatry. Int J Sci Res Arch 2023; 8(1): 740-53. doi: 10.30574/ijsra.2023.8.1.0119Hovstadius B, Petersson G. Factors leading to excessive polypharmacy. Clin Geriatr Med 2012; 28(2): 159-72. doi: 10.1016/j.cger.2012.01.001 PMID: 22500536Tamene FB, Sema FD, Sendekie AK. Antipsychotic polypharmacy and associated factors among patients with schizophrenia: Multicenter cross-sectional study in Northwest Ethiopia. PLoS One 2023; 18(8): e0290037. doi: 10.1371/journal.pone.0290037 PMID: 37578965Benz MB, Epstein-Lubow G, Weinstock LM, Gaudiano BA. Polypharmacy among patients with major depressive disorder and co-occurring substance use disorders in a psychiatric hospital setting. J Clin Psychopharmacol 2023; 43(3): 273-7. doi: 10.1097/JCP.0000000000001681 PMID: 37039705Harding SL, Ellis KA, Boisseau J, Petreca V. Psychiatric deprescribing: A narrative review. J Am Psychiatr Nurses Assoc 2023; 10783903231185353. doi: 10.1177/10783903231185353 PMID: 37392084Freudenreich O, Kontos N, Querques J. Psychiatric polypharmacy: A clinical approach based on etiology and differential diagnosis. Harv Rev Psychiatry 2012; 20(2): 79-85. doi: 10.3109/10673229.2012.677358 PMID: 22512741Fava M, Davidson KG. Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am 1996; 19(2): 179-200. doi: 10.1016/S0193-953X(05)70283-5 PMID: 8827185Chtibi M, Zarouf H, Hanine I, Belbachir S, Ouanass A. Ultra-resistant schizophrenia comorbid with temporal epilepsy: A case report. Scholars J Med Case Rep 2023; 11(9): 1603-7. doi: 10.36347/sjmcr.2023.v11i09.009Baron R, Binder A, Wasner G. Neuropathic pain: Diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 2010; 9(8): 807-19. doi: 10.1016/S1474-4422(10)70143-5 PMID: 20650402Granger KT, Sand M, Caswell S, Lizarraga-Valderrama LR, Barnett JH, Moran PM. A new era for schizophrenia drug development – Lessons for the future. Drug Discov Today 2023; 28(7): 103603. doi: 10.1016/j.drudis.2023.103603 PMID: 37142156Chen Y, Ding L. Potential drug-drug interactions in outpatients with depression of a psychiatry department. Saudi Pharm J 2023; 31(2): 207-13. doi: 10.1016/j.jsps.2022.12.004 PMID: 36942274Collins K, Dopheide JA, Wang M, Keshishian T. Best practices for documentation of psychotropic drug-drug interactions in an adult psychiatric clinic. Ment Health Clin 2023; 13(1): 11-7. doi: 10.9740/mhc.2023.02.011 PMID: 36891479Prieto-Garcia JM, Graham L, Alkhabbaz O, Mazzari ALDA. Potential pharmacokinetic interactions of common cardiovascular drugs and selected European and latin American herbal medicines: A scoping review. Plants 2023; 12(3): 623. doi: 10.3390/plants12030623 PMID: 36771707Stein H-C, Strawbridge R, Silman D, Carmellini P, Young AH, Juruena MF. Ketamine’s pharmacokinetic and pharmacodynamic interactions with anticonvulsants, and their implications for psychiatry: A scoping review protocol. medRxiv, 23285702 2023; 2023: 5702.: 2023.02. doi: 10.1101/2023.02.09.23285702Zaccara G, Franco V. Pharmacokinetic interactions between antiseizure and psychiatric medications. Curr Neuropharmacol 2023; 21(8): 1666-90. doi: 10.2174/1570159X20666220524121645 PMID: 35611779Ramadhani P, Fauziah F, Kurnia NM. Polypharmacy and drug interactions in geriatric patients with type 2 diabetes mellitus at the internal medicine inpatient installation at RSUP Dr. M. Djamil Padang. Int J Pharmaceut Sci Med 2023; 8: 1-6. doi: 10.47760/ijpsm.2023.v08i05.001Kyler KE, Hall M, Antoon JW, et al. Polypharmacy among medicaid-insured children with and without documented obesity. Pharmacotherapy 2023; 43(7): 588-95. doi: 10.1002/phar.2755 PMID: 36564960Pisani F, Rosa Pisani L, Barbieri MA, de Leon J, Spina E. Optimization of therapy in patients with epilepsy and psychiatric comorbidities: Key points. Curr Neuropharmacol 2023; 21(8): 1755-66. doi: 10.2174/1570159X20666220526144314 PMID: 35619263Hefner G, Wolff J, Hahn M, et al. Prevalence and sort of pharmacokinetic drug–drug interactions in hospitalized psychiatric patients. J Neural Transm (Vienna) 2020; 127(8): 1185-98. doi: 10.1007/s00702-020-02214-x PMID: 32519194Meyer JM, Stahl SM. The Lithium Handbook. Cambridge University Press. 2023.Preskorn SH. Drug-drug interactions in psychiatric practice, part 1: reasons, importance, and strategies to avoid and recognize them. J Psychiatr Pract 2018; 24(4): 261-8. doi: 10.1097/PRA.0000000000000322 PMID: 30427809Johannessen Landmark C, Eyal S, Burns ML, Franco V, Johannessen SI. Pharmacological aspects of antiseizure medications: From basic mechanisms to clinical considerations of drug interactions and use of therapeutic drug monitoring. Epileptic Disord 2023; 25(4): 454-71. doi: 10.1002/epd2.20069 PMID: 37259844Yang Y, Li Z, Wang Y, et al. The regulatory relationship between NAMPT and PD-L1 in cancer and identification of a dual-targeting inhibitor. EMBO Mol Med 2024; 16(4): 885-903. doi: 10.1038/s44321-024-00051-z PMID: 38448544Jafari M, Mirzaie M, Bao J, et al. Bipartite network models to design combination therapies in acute myeloid leukaemia. Nat Commun 2022; 13(1): 2128. doi: 10.1038/s41467-022-29793-5 PMID: 35440130Prichard MN, Shipman C Jr. A three-dimensional model to analyze drug-drug interactions. Antiviral Res 1990; 14(4-5): 181-205. doi: 10.1016/0166-3542(90)90001-N PMID: 2088205Mutalik M, Sanghavi D. Review of drug interactions: A comprehensive update. Br J Pharm Res 2014; 4(8): 954-80. doi: 10.9734/BJPR/2014/8531Koch G, Schropp J, Jusko WJ. Assessment of non-linear combination effect terms for drug–drug interactions. J Pharmacokinet Pharmacodyn 2016; 43(5): 461-79. doi: 10.1007/s10928-016-9490-0 PMID: 27638639Bijnsdorp IV, Giovannetti E, Peters GJ. Analysis of drug interactions. Methods Mol Biol 2011; 731: 421-34. doi: 10.1007/978-1-61779-080-5_34Niu J, Straubinger RM, Mager DE. Pharmacodynamic drug–drug interactions. Clin Pharmacol Ther 2019; 105(6): 1395-406. doi: 10.1002/cpt.1434 PMID: 30912119Farkas D, Shader RI, von Moltke LL, Greenblatt DJ. Mechanisms and consequences of drug-drug interactions.Pharmaceutical sciences encyclopedia: Drug discovery, development, and manufacturing. Wiley Online Library 2008; pp. 879-917. doi: 10.1002/9780470249031.ch25Tallarida RJ. Drug synergism: Its detection and applications. J Pharmacol Exp Ther 2001; 298(3): 865-72. PMID: 11504778Chou TC. Theoretical basis, experimental design, and computerized simulation of synergism and antagonism in drug combination studies. Pharmacol Rev 2006; 58(3): 621-81. doi: 10.1124/pr.58.3.10 PMID: 16968952Yin N, Ma W, Pei J, Ouyang Q, Tang C, Lai L. Synergistic and antagonistic drug combinations depend on network topology. PLoS One 2014; 9(4): e93960. doi: 10.1371/journal.pone.0093960 PMID: 24713621Rose JE, Levin ED. Concurrent agonist-antagonist administration for the analysis and treatment of drug dependence. Pharmacol Biochem Behav 1992; 41(1): 219-26. doi: 10.1016/0091-3057(92)90086-U PMID: 1539072Hefner G, Hahn M, Hiemke C, et al. Pharmacodynamic drug-drug interactions of QT-prolonging drugs in hospitalized psychiatric patients. J Neural Transm (Vienna) 2021; 128(2): 243-52. doi: 10.1007/s00702-020-02291-y PMID: 33417009Bačar Bole C, Nagode K, Pišlar M, Mrhar A, Grabnar I, Vovk T. Potential drug-drug interactions among patients with Schizophrenia spectrum disorders: Prevalence, association with risk factors, and replicate analysis in 2021. Medicina (Kaunas) 2023; 59(2): 284. doi: 10.3390/medicina59020284 PMID: 36837485Stassen HH, Bachmann S, Bridler R, et al. Detailing the effects of polypharmacy in psychiatry: Longitudinal study of 320 patients hospitalized for depression or schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272(4): 603-19. doi: 10.1007/s00406-021-01358-5 PMID: 34822007Schulze Westhoff M, Schröder S, Heck J, et al. Drug safety profiles of geriatric patients referred to consultation psychiatry in the emergency department-A retrospective cohort study. J Geriatr Psychiatry Neurol 2023; 36(5): 407-16. doi: 10.1177/08919887221149158 PMID: 36592403Lassen S, Heintz T, Pedersen T, et al. Nationwide study on antipsychotic polypharmacy among forensic psychiatric patients. Int J Circumpolar Health 2023; 82(1): 2218654. doi: 10.1080/22423982.2023.2218654 PMID: 37300837Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation making it safe and sound London. London: The King’s Fund 2013.Koch E, Kämpe A, Alver M, et al. Polygenic liability for antipsychotic dosage and polypharmacy-a real-world registry and biobank study. neuropsychopharmacology 2023; 2023 doi: 10.21203/rs.3.rs-3308026/v1Wu R, Li M. Antipsychotic polypharmacy in a geriatric patient. Am J Geriatr Psychiatry 2023; 31(3): S63-4. doi: 10.1016/j.jagp.2022.12.223Lunghi C, Rochette L, Massamba V, Tardif I, Ouali A, Sirois C. Psychiatric and non-psychiatric polypharmacy among older adults with schizophrenia: Trends from a population-based study between 2000 and 2016. Front Pharmacol 2023; 14: 1080073. doi: 10.3389/fphar.2023.1080073 PMID: 36825148Lawrence C, Hou R, Chamberlain S. What is the relative efficacy and tolerability of antipsychotic polypharmacy and high dose antipsychotic therapy compared to the use of antipsychotic monotherapy at standard doses in the treatment of Schizophrenia? Uni Southampton 2023; 2023: 1.Turk A, Wong G, Mahtani KR, et al. Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: A realist review. BMC Med 2022; 20(1): 297. doi: 10.1186/s12916-022-02475-1 PMID: 36042454Carlson DM, Yarns BC. Managing medical and psychiatric multimorbidity in older patients. Ther Adv Psychopharmacol 2023; 13: 20451253231195274. doi: 10.1177/20451253231195274 PMID: 37663084Matos A, Bankes DL, Bain KT, Ballinghoff T, Turgeon J. Opioids, polypharmacy, and drug interactions: A technological paradigm shift is needed to ameliorate the ongoing opioid epidemic. Pharmacy (Basel) 2020; 8(3): 154. doi: 10.3390/pharmacy8030154 PMID: 32854271Bainbridge J, Barnhart R, Fuller R, et al. The role of clinical pharmacists in patient-centric comprehensive multiple sclerosis care. Int J MS Care 2023. PMID: 38213670Price J. Drug–drug interactions: A pharmacovigilance road less traveled. Clin Ther 2023; 45(2): 94-8. doi: 10.1016/j.clinthera.2022.12.005 PMID: 36641261Salicru S. Leadership results: How to create adaptive leaders and high-performing organisations for an uncertain world. John Wiley & Sons 2017.Dow P, Michaud V, Turgeon J. Multidrug interactions: Why do they occur and how to handle? Clin Ther 2023; 45(2): 99-105. doi: 10.1016/j.clinthera.2022.12.012 PMID: 36682993Koziolek M, Alcaro S, Augustijns P, et al. The mechanisms of pharmacokinetic food-drug interactions – A perspective from the UNGAP group. Eur J Pharm Sci 2019; 134: 31-59. doi: 10.1016/j.ejps.2019.04.003 PMID: 30974173Burnette C, Smithy W, Strock D, Sivesind TE, Dellavalle R. The importance of gender-neutral terminology in risk evaluation and mitigation strategy programs: A call to action. JMIR Dermatol 2023; 6: e45329. doi: 10.2196/45329Patel D, Bertz R, Ren S, Boulton DW, Någård M. A systematic review of gastric acid-reducing agent-mediated drug–drug interactions with orally administered medications. Clin Pharmacokinet 2020; 59(4): 447-62. doi: 10.1007/s40262-019-00844-3 PMID: 31788764Tilson H, Hines LE, McEvoy G, et al. Recommendations for selecting drug–drug interactions for clinical decision support. Am J Health Syst Pharm 2016; 73(8): 576-85. doi: 10.2146/ajhp150565 PMID: 27045070Hines LE, Malone DC, Murphy JE. Recommendations for generating, evaluating, and implementing drug-drug interaction evidence. Pharmacotherapy 2012; 32(4): 304-13. doi: 10.1002/j.1875-9114.2012.01024.x PMID: 22461120Payne TH, Hines LE, Chan RC, et al. Recommendations to improve the usability of drug-drug interaction clinical decision support alerts. J Am Med Inform Assoc 2015; 22(6): 1243-50. doi: 10.1093/jamia/ocv011 PMID: 25829460Åstrand B. Avoiding drug-drug interactions. Chemotherapy 2009; 55(4): 215-20. doi: 10.1159/000218100 PMID: 19439942Hochheiser H, Jing X, Garcia EA, et al. A minimal information model for potential drug-drug interactions. Front Pharmacol 2021; 11: 608068. doi: 10.3389/fphar.2020.608068 PMID: 33762928Goodlet KJ, Zmarlicka MT, Peckham AM. Drug–drug interactions and clinical considerations with co-administration of antiretrovirals and psychotropic drugs. CNS Spectr 2019; 24(3): 287-312. doi: 10.1017/S109285291800113X PMID: 30295215Lucà F, Oliva F, Abrignani MG, et al. Management of patients treated with direct oral anticoagulants in clinical practice and challenging scenarios. J Clin Med 2023; 12(18): 5955. doi: 10.3390/jcm12185955 PMID: 37762897Higano CS, Hafron J. Adherence with oral anticancer therapies: Clinical trial vs. real-world experiences with a focus on prostate cancer. J Urol 2023; 209(3): 485-93. doi: 10.1097/JU.0000000000003081 PMID: 36472138BH JG, Shankar SJ, Munisamy M, RS A, Sagar VS. Treatment and management of mental health conditions during pregnancy and postpartum. Obstet Gynecol 2023; 141(6): 1262-88.Meaddough EL, Sarasua SM, Fasolino TK, Farrell CL. The impact of pharmacogenetic testing in patients exposed to polypharmacy: A scoping review. Pharmacogenomics J 2021; 21(4): 409-22. doi: 10.1038/s41397-021-00224-w PMID: 34140647Sharp CN, Linder MW, Valdes R Jr. Polypharmacy: A healthcare conundrum with a pharmacogenetic solution. Crit Rev Clin Lab Sci 2020; 57(3): 161-80. doi: 10.1080/10408363.2019.1678568 PMID: 31680605Sardo P. Improving patient outcomes by managing polypharmacy. 2023. Available from: https://rxce.com/materials/Improving-Patient-Outcomes-by-Managing-Polypharmacy-Ceu.pdfFinkelstein J, Friedman C, Hripcsak G, Cabrera M. Potential utility of precision medicine for older adults with polypharmacy: A case series study. Pharm Genomics Pers Med 2016; 9: 31-45. doi: 10.2147/PGPM.S101474 PMID: 27143951Liu J, Friedman C, Finkelstein J. Pharmacogenomic approaches for automated medication risk assessment in people with polypharmacy. AMIA Jt Summits Transl Sci Proc 2018; 2017: 142-51. PMID: 29888060Corona G, Cucinotta D, Di Lorenzo G, et al. The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction. J Endocrinol Invest 2023; 46(6): 1241-74. doi: 10.1007/s40618-023-02015-5 PMID: 36698034Wasylewicz ATM. Contextualized clinical decision support to detect and prevent adverse drug events. PhD thesis, Eindhoven University of Technology 2023.Alexander JL, Dennerstein L, Kotz K, Richardson G. Women, anxiety and mood: A review of nomenclature, comorbidity and epidemiology. Expert review of neurotherapeutics 2007; 7(S1): S45-58. doi: 10.1586/14737175.7.11s.S45Tuman TC, Tuman BA, Sereflican B, Yildirim O. 8th International Congress on Psychopharmacology. Klinik Psikofarmakol BBülteni 2016; 26(1): S278.Terman SW, Niznik JD, Growdon ME, Gerlach LB, Burke JF. Secular trends in central nervous system-active polypharmacy among serial cross-sections of US adults, 2009-2020. Drugs Aging 2023; 40(10): 941-51. doi: 10.1007/s40266-023-01066-w PMID: 37695395Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: A narrative review. Expert Opin Drug Saf 2018; 17(12): 1185-96. doi: 10.1080/14740338.2018.1546841 PMID: 30540223Zidan A, Awaisu A. Inappropriate polypharmacy management versus deprescribing: A review on their relationship. Basic Clin Pharmacol Toxicol 2023. PMID: 37350370Cournoyea M. Medical explanations in evolutionary medicine, network medicine, and medically unexplained physical symptoms. PhD thesis, University of Toronto 2018.Fujita K, Masnoon N, Mach J, O’Donnell LK, Hilmer SN. Polypharmacy and precision medicine. Cambridge Prisms: Precision Medicine 2023; 1: e22. doi: 10.1017/pcm.2023.10 PMID: 38550925Wong EHF, Yocca F, Smith MA, Lee CM. Challenges and opportunities for drug discovery in psychiatric disorders: the drug hunters’ perspective. Int J Neuropsychopharmacol 2010; 13(9): 1269-84. doi: 10.1017/S1461145710000866 PMID: 20716397Belforte JE. Moving forward precision medicine in psychiatry. Biol Psychiatry 2023; 94(8): 607-8. doi: 10.1016/j.biopsych.2023.07.007 PMID: 37718031Brown L, Eum S, Haga SB, Strawn JR, Zierhut H. Clinical utilization of pharmacogenetics in psychiatry–perspectives of pharmacists, genetic counselors, implementation science, clinicians, and industry. Pharmacopsychiatry 2020; 53(4): 162-73. doi: 10.1055/a-0975-9595 PMID: 31509860Johansson Å, Andreassen OA, Brunak S, et al. Precision medicine in complex diseases-molecular subgrouping for improved prediction and treatment stratification. J Intern Med 2023; 294(4): 378-96. doi: 10.1111/joim.13640 PMID: 37093654McGreevey JD III, Mallozzi CP, Perkins RM, Shelov E, Schreiber R. Reducing alert burden in electronic health records: State of the art recommendations from four health systems. Appl clinic inform 2020; 11(1): 1-12. doi: 10.1055/s-0039-3402715Leinert C, Fotteler M, Kocar TD, et al. Supporting SURgery with GEriatric Co-Management and AI (SURGE-Ahead): A study protocol for the development of a digital geriatrician. PLoS One 2023; 18(6): e0287230. doi: 10.1371/journal.pone.0287230 PMID: 37327245Carloni T. Abstracts from the 2022 Annual Scientific Meeting of the Canadian Academy of Geriatric Psychiatry and Canadian Coalition for Seniors’ Mental Healths: October 14-15, 2022; Montreal, Quebec. Can Geriatr J 2023; 26(3): 412-42. doi: 10.5770/cgj.26.678