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.
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.
Code | Description | Entity type | Category | Coding System (Read) |
---|---|---|---|---|
1612.00 | Appetite loss - anorexia | res36: Eating disorder | diagnostic | Read |
1612.11 | Anorexia symptom | res36: Eating disorder | diagnostic | Read |
1614.00 | Excessive eating - polyphagia | res36: Eating disorder | diagnostic | Read |
1614.11 | Hyperalimentation - symptom | res36: Eating disorder | diagnostic | Read |
1614.12 | Polyphagia symptom | res36: Eating disorder | diagnostic | Read |
8HTN.00 | Referral to eating disorders clinic | res36: Eating disorder | diagnostic | Read |
9Nk9.00 | Seen in eating disorder clinic | res36: Eating disorder | diagnostic | Read |
E271.00 | Anorexia nervosa | res36: Eating disorder | diagnostic | Read |
E275.00 | Other and unspecified non-organic eating disorders | res36: Eating disorder | diagnostic | Read |
E275000 | Unspecified non-organic eating disorder | res36: Eating disorder | diagnostic | Read |
E275100 | Bulimia (non-organic overeating) | res36: Eating disorder | diagnostic | Read |
E275111 | Compulsive eating disorder | res36: Eating disorder | diagnostic | Read |
E275y00 | Other specified non-organic eating disorder | res36: Eating disorder | diagnostic | Read |
E275z00 | Non-organic eating disorder NOS | res36: Eating disorder | diagnostic | Read |
Eu50.00 | [X]Eating disorders | res36: Eating disorder | diagnostic | Read |
Eu50000 | [X]Anorexia nervosa | res36: Eating disorder | diagnostic | Read |
Eu50100 | [X]Atypical anorexia nervosa | res36: Eating disorder | diagnostic | Read |
Eu50200 | [X]Bulimia nervosa | res36: Eating disorder | diagnostic | Read |
Eu50211 | [X]Bulimia NOS | res36: Eating disorder | diagnostic | Read |
Eu50212 | [X]Hyperorexia nervosa | res36: Eating disorder | diagnostic | Read |
Eu50300 | [X]Atypical bulimia nervosa | res36: Eating disorder | diagnostic | Read |
Eu50400 | [X]Overeating associated with other psychological disturbncs | res36: Eating disorder | diagnostic | Read |
Eu50411 | [X]Psychogenic overeating | res36: Eating disorder | diagnostic | Read |
Eu50y00 | [X]Other eating disorders | res36: Eating disorder | diagnostic | Read |
Eu50y11 | [X]Pica in adults | res36: Eating disorder | diagnostic | Read |
Eu50z00 | [X]Eating disorder, unspecified | res36: Eating disorder | diagnostic | Read |
Fy05.00 | Nocturnal sleep-related eating disorder | res36: Eating disorder | diagnostic | Read |
R030.00 | [D]Anorexia | res36: Eating disorder | diagnostic | Read |
R030z00 | [D]Anorexia NOS | res36: Eating disorder | diagnostic | Read |
R036.00 | [D]Polyphagia | res36: Eating disorder | diagnostic | Read |
R036000 | [D]Excessive eating | res36: Eating disorder | diagnostic | Read |
R036011 | [D]Bulimia NOS | res36: Eating disorder | diagnostic | Read |
R036100 | [D]Hyperalimentation | res36: Eating disorder | diagnostic | Read |
R036z00 | [D]Polyphagia NOS | res36: Eating disorder | diagnostic | Read |
SN42100 | Starvation | res36: Eating disorder | diagnostic | Read |
U1B3.11 | [X]Starvation | res36: Eating disorder | diagnostic | Read |
Z4B5.00 | Eating disorder counselling | res36: Eating disorder | diagnostic | Read |
ZC2CD00 | Dietary advice for eating disorder | res36: Eating disorder | diagnostic | Read |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH376/version/752/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH376/version/752/detail/?format=json |
R Package |
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To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH376/version/752/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH376/version/752/export/codes/?format=json |
CSV | site_root/phenotypes/PH376/version/752/export/codes/ |
R Package |
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Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
752 | Eating Disorder | ieuan.scanlon | 2021-10-06 | currently shown |
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