[ { "phenotype_id": "PH376", "phenotype_version_id": 752, "name": "Eating Disorder", "definition": "Background: \n\nLittle is known about the clinical management of patients in primary care following self-harm.\n\n\nMethods: \n\nA descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPRD) during 2001-2013. We identified 49,970 patients with a self-harm episode, 41,500 of whom had one complete year of follow-up.\n\n\nResults: \n\nAmong those with complete follow-up, 26,065 (62.8%, 62.3-63.3) were prescribed psychotropic medication and 6318 (15.2%, 14.9-15.6) were referred to mental health services; 4105 (9.9%, CI 9.6-10.2) were medicated without an antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6-11.2) had a diagnosis but were not subsequently medicated or referred. Patients registered at practices in the most deprived localities were 27.1% (CI 21.5-32.2) less likely to be referred than those in the least deprived. Despite a specifically flagged NICE 'Do not do' recommendation in 2011 against prescribing tricyclic antidepressants following self-harm because of their potentially lethal toxicity in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert issued in 2011.\n\n\nConclusions: \n\nA relatively small percentage of these vulnerable patients are referred to mental health services, and reduced likelihood of referral in more deprived localities reflects a marked health inequality. National clinical guidelines have not yet been effective in reducing rates of tricyclic antidepressant prescribing for this high-risk group.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Matthew J Carr, Darren M Ashcroft, Evangelos Kontopantelis, David While, Yvonne Awenant, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb, Clinical management following self-harm in a UK-wide primary care cohort. Journal of Affective Disorders, 197(2016) 182-188, 2016." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:16:24.387982Z", "author": "Matthew J Carr, Darren M Ashscroft, Evangelos Kontopantelis, David While, Yvonne Awenant, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:16:24.388010Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/01/2001 - 31/12/2012", "concept_information": [ { "concept_id": 1706, "concept_version_id": 4550, "concept_name": "Eating Disorder - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH376", "phenotype_version_id": 752, "phenotype_name": "Eating Disorder", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "1612.00", "description": "Appetite loss - anorexia", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1612.11", "description": "Anorexia symptom", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1614.00", "description": "Excessive eating - polyphagia", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1614.11", "description": "Hyperalimentation - symptom", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1614.12", "description": "Polyphagia symptom", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HTN.00", "description": "Referral to eating disorders clinic", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9Nk9.00", "description": "Seen in eating disorder clinic", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E271.00", "description": "Anorexia nervosa", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E275.00", "description": "Other and unspecified non-organic eating disorders", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E275000", "description": "Unspecified non-organic eating disorder", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E275100", "description": "Bulimia (non-organic overeating)", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E275111", "description": "Compulsive eating disorder", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E275y00", "description": "Other specified non-organic eating disorder", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "E275z00", "description": "Non-organic eating disorder NOS", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50.00", "description": "[X]Eating disorders", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50000", "description": "[X]Anorexia nervosa", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50100", "description": "[X]Atypical anorexia nervosa", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50200", "description": "[X]Bulimia nervosa", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50211", "description": "[X]Bulimia NOS", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50212", "description": "[X]Hyperorexia nervosa", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50300", "description": "[X]Atypical bulimia nervosa", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50400", "description": "[X]Overeating associated with other psychological disturbncs", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50411", "description": "[X]Psychogenic overeating", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50y00", "description": "[X]Other eating disorders", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50y11", "description": "[X]Pica in adults", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Eu50z00", "description": "[X]Eating disorder, unspecified", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Fy05.00", "description": "Nocturnal sleep-related eating disorder", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R030.00", "description": "[D]Anorexia", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R030z00", "description": "[D]Anorexia NOS", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R036.00", "description": "[D]Polyphagia", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R036000", "description": "[D]Excessive eating", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R036011", "description": "[D]Bulimia NOS", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R036100", "description": "[D]Hyperalimentation", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R036z00", "description": "[D]Polyphagia NOS", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "SN42100", "description": "Starvation", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "U1B3.11", "description": "[X]Starvation", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Z4B5.00", "description": "Eating disorder counselling", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZC2CD00", "description": "Dietary advice for eating disorder", "attributes": { "Entity type": "res36: Eating disorder", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/pp44-4g37", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 752, "version_name": "Eating Disorder", "version_date": "2021-10-06T16:16:24.410331Z", "is_published": true, "is_latest": true } ] } ]