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
Overview
Phenotype TypeDrugSexBothValid Event Date Range01/01/2001 - 31/12/2012Coding SystemMultilex codesData SourcesCollectionsClinicalCodes RepositoryPhenotype LibraryTagsNo dataDefinition
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.
Implementation
No dataImplementation
Clinical Code List
PUBLISHED - 173 Codes
Publication
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.
No dataCitation Requirements
API
To Export Phenotype Details:
Format API JSON site_root/api/v1/phenotypes/PH365/version/730/detail/?format=json R Package library(ConceptLibraryClient)
# Connect to API
client = ConceptLibraryClient::Connection$new(public=TRUE)
# Get details of phenotype
phenotype_details = client$phenotypes$get_detail(
'PH365',
version_id=730
)Py Package from pyconceptlibraryclient import Client
# Connect to API
client = Client(public=True)
# Get codelist of phenotype
phenotype_codelist = client.phenotypes.get_detail(
'PH365',
version_id=730
)To Export Phenotype Code List:
Format API JSON site_root/api/v1/phenotypes/PH365/version/730/export/codes/?format=json CSV site_root/phenotypes/PH365/version/730/export/codes/ R Package library(ConceptLibraryClient)
# Connect to API
client = ConceptLibraryClient::Connection$new(public=TRUE)
# Get codelist of phenotype
phenotype_codelist = client$phenotypes$get_codelist(
'PH365',
version_id=730
)Py Package 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
)Version History