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) |
---|---|---|---|---|
E21..00 | Personality disorders | res36: Personality disorder | diagnostic | Read |
E21..11 | Neurotic personality disorder | res36: Personality disorder | diagnostic | Read |
E210.00 | Paranoid personality disorder | res36: Personality disorder | diagnostic | Read |
E211.00 | Affective personality disorder | res36: Personality disorder | diagnostic | Read |
E211000 | Unspecified affective personality disorder | res36: Personality disorder | diagnostic | Read |
E211100 | Hypomanic personality disorder | res36: Personality disorder | diagnostic | Read |
E211200 | Depressive personality disorder | res36: Personality disorder | diagnostic | Read |
E211300 | Cyclothymic personality disorder | res36: Personality disorder | diagnostic | Read |
E211z00 | Affective personality disorder NOS | res36: Personality disorder | diagnostic | Read |
E212.00 | Schizoid personality disorder | res36: Personality disorder | diagnostic | Read |
E212000 | Unspecified schizoid personality disorder | res36: Personality disorder | diagnostic | Read |
E212z00 | Schizoid personality disorder NOS | res36: Personality disorder | diagnostic | Read |
E213.00 | Explosive personality disorder | res36: Personality disorder | diagnostic | Read |
E214.00 | Compulsive personality disorders | res36: Personality disorder | diagnostic | Read |
E214.11 | Anancastic personality | res36: Personality disorder | diagnostic | Read |
E214000 | Anankastic personality | res36: Personality disorder | diagnostic | Read |
E214z00 | Compulsive personality disorder NOS | res36: Personality disorder | diagnostic | Read |
E215.00 | Histrionic personality disorders | res36: Personality disorder | diagnostic | Read |
E215.11 | Hysterical personality disorders | res36: Personality disorder | diagnostic | Read |
E215000 | Unspecified histrionic personality disorder | res36: Personality disorder | diagnostic | Read |
E215z00 | Histrionic personality disorder NOS | res36: Personality disorder | diagnostic | Read |
E216.00 | Inadequate personality disorder | res36: Personality disorder | diagnostic | Read |
E217.00 | Antisocial or sociopathic personality disorder | res36: Personality disorder | diagnostic | Read |
E21y.00 | Other personality disorders | res36: Personality disorder | diagnostic | Read |
E21y000 | Narcissistic personality disorder | res36: Personality disorder | diagnostic | Read |
E21y100 | Avoidant personality disorder | res36: Personality disorder | diagnostic | Read |
E21y200 | Borderline personality disorder | res36: Personality disorder | diagnostic | Read |
E21y300 | Passive-aggressive personality disorder | res36: Personality disorder | diagnostic | Read |
E21y400 | Eccentric personality disorder | res36: Personality disorder | diagnostic | Read |
E21y500 | Immature personality disorder | res36: Personality disorder | diagnostic | Read |
E21y600 | Masochistic personality disorder | res36: Personality disorder | diagnostic | Read |
E21y700 | Psychoneurotic personality disorder | res36: Personality disorder | diagnostic | Read |
E21yz00 | Other personality disorder NOS | res36: Personality disorder | diagnostic | Read |
E21z.00 | Personality disorder NOS | res36: Personality disorder | diagnostic | Read |
E21z.11 | Psychopathic personality | res36: Personality disorder | diagnostic | Read |
Eu06000 | [X]Organic personality disorder | res36: Personality disorder | diagnostic | Read |
Eu06011 | [X]Organic pseudopsychopathic personality | res36: Personality disorder | diagnostic | Read |
Eu21.17 | [X]Pseudopsychopathic schizophrenia | res36: Personality disorder | diagnostic | Read |
Eu21.18 | [X]Schizotypal personality disorder | res36: Personality disorder | diagnostic | Read |
Eu34011 | [X]Affective personality disorder | res36: Personality disorder | diagnostic | Read |
Eu34112 | [X]Depressive personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60.00 | [X]Specific personality disorders | res36: Personality disorder | diagnostic | Read |
Eu60000 | [X]Paranoid personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60013 | [X]Querulant personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60014 | [X]Sensitive paranoid personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60100 | [X]Schizoid personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60200 | [X]Dissocial personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60212 | [X]Antisocial personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60213 | [X]Asocial personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60214 | [X]Psychopathic personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60215 | [X]Sociopathic personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60300 | [X]Emotionally unstable personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60311 | [X]Aggressive personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60312 | [X]Borderline personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60313 | [X]Explosive personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60400 | [X]Histrionic personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60411 | [X]Hysterical personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60412 | [X]Psychoinfantile personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60500 | [X]Anankastic personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60511 | [X]Compulsive personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60512 | [X]Obsessional personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60513 | [X]Obsessive-compulsive personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60600 | [X]Anxious [avoidant] personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60700 | [X]Dependent personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60711 | [X]Asthenic personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60712 | [X]Inadequate personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60713 | [X]Passive personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60714 | [X]Self defeating personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60y00 | [X]Other specific personality disorders | res36: Personality disorder | diagnostic | Read |
Eu60y11 | [X]Eccentric personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60y12 | [X]Haltlose type personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60y13 | [X]Immature personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60y14 | [X]Narcissistic personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60y16 | [X]Psychoneurotic personality disorder | res36: Personality disorder | diagnostic | Read |
Eu60z00 | [X]Personality disorder, unspecified | res36: Personality disorder | diagnostic | Read |
Eu61.00 | [X]Mixed and other personality disorders | res36: Personality disorder | diagnostic | Read |
Eu84511 | [X]Autistic psychopathy | res36: Personality disorder | diagnostic | Read |
Eu94211 | [X]Affectionless psychopathy | res36: Personality disorder | diagnostic | Read |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH384/version/768/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH384/version/768/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH384/version/768/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH384/version/768/export/codes/?format=json |
CSV | site_root/phenotypes/PH384/version/768/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
768 | Personality Disorder | ieuan.scanlon | 2021-10-06 | currently shown |
Export - export all codes into a csv file/JSON/XML for the current phenotype version.
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