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Personality Disorder

Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft

Type
Disease or Syndrome
ID
PH889
Version ID
1857
Data Sources
Valid event data range
01/01/2001 - 31/12/2014
Sex
Female, Male
Agreement Date
2018-10-15
Coding system
Read codes v2 ICD10 codes
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Background:

Self-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide.

Methods:

The UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001–14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks.

Findings:

Overall incidence of self-harm in older adults aged 65 years and older was 4·1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11·7%) of 2854 adults were referred to mental health services, 1692 (59·3%) were prescribed an antidepressant, and 336 (11·8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2·10 [95% CI 2·03–2·17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1·20 [1·17–1·23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145·4 [95% CI 53·9–392·3]) was observed in the self-harm cohort.

Interpretation:

Within primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions.

Publications

  • Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft, Self-harm in a primary care cohort of older people incidence, clinical management, and risk of suicide and other causes of death. Psychiatry, 5, 2018.

Clinical Code List

Rows: 81
Code Description Entity type Coding System (ICD-10 Read) Category
E21..00 Personality disorders res69: person_disorder Read diagnostic
E21..11 Neurotic personality disorder res69: person_disorder Read diagnostic
E210.00 Paranoid personality disorder res69: person_disorder Read diagnostic
E211.00 Affective personality disorder res69: person_disorder Read diagnostic
E211000 Unspecified affective personality disorder res69: person_disorder Read diagnostic
E211100 hypomanic personality disorder res69: person_disorder Read diagnostic
E211200 depressive personality disorder res69: person_disorder Read diagnostic
E211300 cyclothymic personality disorder res69: person_disorder Read diagnostic
E211z00 Affective personality disorder NOS res69: person_disorder Read diagnostic
E212.00 schizoid personality disorder res69: person_disorder Read diagnostic
E212000 unspecified schizoid personality disorder res69: person_disorder Read diagnostic
E212z00 schizoid personality disorder nos res69: person_disorder Read diagnostic
E213.00 Explosive personality disorder res69: person_disorder Read diagnostic
E214.00 Compulsive personality disorders res69: person_disorder Read diagnostic
E214.11 Anancastic personality res69: person_disorder Read diagnostic
E214000 Anankastic personality res69: person_disorder Read diagnostic
E214z00 Compulsive personality disorder NOS res69: person_disorder Read diagnostic
E215.00 Histrionic personality disorders res69: person_disorder Read diagnostic
E215.11 Hysterical personality disorders res69: person_disorder Read diagnostic
E215000 Unspecified histrionic personality disorder res69: person_disorder Read diagnostic
E215z00 Histrionic personality disorder NOS res69: person_disorder Read diagnostic
E216.00 Inadequate personality disorder res69: person_disorder Read diagnostic
E217.00 Antisocial or sociopathic personality disorder res69: person_disorder Read diagnostic
E21y.00 Other personality disorders res69: person_disorder Read diagnostic
E21y000 Narcissistic personality disorder res69: person_disorder Read diagnostic
E21y100 Avoidant personality disorder res69: person_disorder Read diagnostic
E21y200 Borderline personality disorder res69: person_disorder Read diagnostic
E21y300 Passive-aggressive personality disorder res69: person_disorder Read diagnostic
E21y400 Eccentric personality disorder res69: person_disorder Read diagnostic
E21y500 Immature personality disorder res69: person_disorder Read diagnostic
E21y600 Masochistic personality disorder res69: person_disorder Read diagnostic
E21y700 Psychoneurotic personality disorder res69: person_disorder Read diagnostic
E21yz00 Other personality disorder NOS res69: person_disorder Read diagnostic
E21z.00 Personality disorder NOS res69: person_disorder Read diagnostic
E21z.11 Psychopathic personality res69: person_disorder Read diagnostic
Eu06000 [X]Organic personality disorder res69: person_disorder Read diagnostic
Eu06011 [X]Organic pseudopsychopathic personality res69: person_disorder Read diagnostic
Eu21.17 [x]pseudopsychopathic schizophrenia res69: person_disorder Read diagnostic
Eu21.18 [x]schizotypal personality disorder res69: person_disorder Read diagnostic
Eu34011 [X]Affective personality disorder res69: person_disorder Read diagnostic
Eu34112 [x]depressive personality disorder res69: person_disorder Read diagnostic
Eu60.00 [X]Specific personality disorders res69: person_disorder Read diagnostic
Eu60000 [X]Paranoid personality disorder res69: person_disorder Read diagnostic
Eu60013 [X]Querulant personality disorder res69: person_disorder Read diagnostic
Eu60014 [X]Sensitive paranoid personality disorder res69: person_disorder Read diagnostic
Eu60100 [x]schizoid personality disorder res69: person_disorder Read diagnostic
Eu60200 [X]Dissocial personality disorder res69: person_disorder Read diagnostic
Eu60211 [X]Amoral personality disorder res69: person_disorder Read diagnostic
Eu60212 [X]Antisocial personality disorder res69: person_disorder Read diagnostic
Eu60213 [X]Asocial personality disorder res69: person_disorder Read diagnostic
Eu60214 [X]Psychopathic personality disorder res69: person_disorder Read diagnostic
Eu60215 [X]Sociopathic personality disorder res69: person_disorder Read diagnostic
Eu60300 [X]Emotionally unstable personality disorder res69: person_disorder Read diagnostic
Eu60311 [X]Aggressive personality disorder res69: person_disorder Read diagnostic
Eu60312 [X]Borderline personality disorder res69: person_disorder Read diagnostic
Eu60313 [X]Explosive personality disorder res69: person_disorder Read diagnostic
Eu60400 [X]Histrionic personality disorder res69: person_disorder Read diagnostic
Eu60411 [X]Hysterical personality disorder res69: person_disorder Read diagnostic
Eu60412 [X]Psychoinfantile personality disorder res69: person_disorder Read diagnostic
Eu60500 [X]Anankastic personality disorder res69: person_disorder Read diagnostic
Eu60511 [X]Compulsive personality disorder res69: person_disorder Read diagnostic
Eu60512 [X]Obsessional personality disorder res69: person_disorder Read diagnostic
Eu60513 [X]Obsessive-compulsive personality disorder res69: person_disorder Read diagnostic
Eu60600 [x]anxious [avoidant] personality disorder res69: person_disorder Read diagnostic
Eu60700 [X]Dependent personality disorder res69: person_disorder Read diagnostic
Eu60711 [X]Asthenic personality disorder res69: person_disorder Read diagnostic
Eu60712 [X]Inadequate personality disorder res69: person_disorder Read diagnostic
Eu60713 [X]Passive personality disorder res69: person_disorder Read diagnostic
Eu60714 [X]Self defeating personality disorder res69: person_disorder Read diagnostic
Eu60800 [X]Addictive personality res69: person_disorder Read diagnostic
Eu60y00 [X]Other specific personality disorders res69: person_disorder Read diagnostic
Eu60y11 [X]Eccentric personality disorder res69: person_disorder Read diagnostic
Eu60y12 [X]Haltlose type personality disorder res69: person_disorder Read diagnostic
Eu60y13 [X]Immature personality disorder res69: person_disorder Read diagnostic
Eu60y14 [X]Narcissistic personality disorder res69: person_disorder Read diagnostic
Eu60y16 [X]Psychoneurotic personality disorder res69: person_disorder Read diagnostic
Eu60z00 [X]Personality disorder; unspecified res69: person_disorder Read diagnostic
Eu60z11 [X]Character neurosis NOS res69: person_disorder Read diagnostic
Eu60z12 [X]Pathological personality NOS res69: person_disorder Read diagnostic
Eu61.00 [X]Mixed and other personality disorders res69: person_disorder Read diagnostic
Eu84511 [x]autistic psychopathy res69: person_disorder Read diagnostic
Rows: 2
Code Description Entity type Coding System (ICD-10 Read) Category
F60 Specific personality disorders res69: person_disorder ICD-10 diagnostic
F61 Mixed and other personality disorders res69: person_disorder ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH889/version/1857/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH889/version/1857/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH889', '1857', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH889/version/1857/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH889/version/1857/export/codes/?format=json
CSV site_root/phenotypes/PH889/version/1857/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH889', '1857', api_client=client)

Version History

Version
ID
Name Owner Publish date
1857 Personality Disorder ieuan.scanlon 2022-04-04 currently shown

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