Atypical APDs

Matthew J Carr, Darren M Ashscroft, Evangelos Kontopantelis, David While, Yvonne Awenant, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb

PH365 / 730 Clinical-Coded Phenotype

  1. Overview

    Phenotype Type
    Drug
    Sex
    Both
    Valid Event Date Range
    01/01/2001 - 31/12/2012
    Coding System
    Multilex codes
    Data Sources
    CPRD GOLD
    Collections
    ClinicalCodes RepositoryPhenotype Library
    Tags
    No data
    Ontology
    No data

  2. Definition

    Background:

    Little is known about the clinical management of patients in primary care following self-harm.

    Methods:

    A 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.

    Results:

    Among 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.

    Conclusions:

    A 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.

  3. Implementation

    Implementation

    No data

  4. Clinical Code List

  5. Publication

    Related publications

    • 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.

    Citation Example

    Matthew J Carr, Darren M Ashscroft, Evangelos Kontopantelis, David While, Yvonne Awenant, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb. PH365 / 730 - Atypical APDs. Phenotype Library [Online]. 06 October 2021. Available from: http://phenotypes.healthdatagateway.org/phenotypes/PH365/version/730/detail/. [Accessed 25 April 2025]

  6. API

    To Export Phenotype Details:

    FormatAPI
    JSON site_root/api/v1/phenotypes/PH365/version/730/detail/?format=json
    R Package

    # Download here

    library(ConceptLibraryClient)


    # Connect to API

    client = ConceptLibraryClient::Connection$new(public=TRUE)


    # Get details of phenotype

    phenotype_details = client$phenotypes$get_detail(
     'PH365',
     version_id=730
    )

    Py Package

    # Download here

    from pyconceptlibraryclient import Client


    # Connect to API

    client = Client(public=True)


    # Get codelist of phenotype

    phenotype_codelist = client.phenotypes.get_detail(
     'PH365',
     version_id=730
    )

    To Export Phenotype Code List:

    FormatAPI
    JSON site_root/api/v1/phenotypes/PH365/version/730/export/codes/?format=json
    R Package

    # Download here

    library(ConceptLibraryClient)


    # Connect to API

    client = ConceptLibraryClient::Connection$new(public=TRUE)


    # Get codelist of phenotype

    phenotype_codelist = client$phenotypes$get_codelist(
     'PH365',
     version_id=730
    )

    Py Package

    # Download here

    from pyconceptlibraryclient import Client


    # Connect to API

    client = Client(public=True)


    # Get codelist of phenotype

    phenotype_codelist = client.phenotypes.get_codelist(
     'PH365',
     version_id=730
    )

  7. Version History

    Version IDNameOwnerPublish date
    Atypical APDs ieuan.scanlon2021-10-06 16:15