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Research article:
Identifying prior signals of bipolar disorder using primary care electronic health records
Reference:
Catharine Morgan, Darren M Ashcroft, Carolyn A Chew-Graham, Matthew Sperrin, Roger T Webb, Anya Francis, Jan Scott, Alison R Yung(2023) Identifying prior signals of bipolar disorder using primary care electronic health records. British Journal of General Practice, doi:
- Link to article
- Abstract
- Background: Bipolar disorders (BD) are serious mental illnesses yet evidence suggests that the diagnosis and treatment of BD can be delayed by around 6 years. Aim: To identify signals of undiagnosed BD using routinely collected electronic health records. Methods: A nested case-control study conducted using the Clinical Practice Research Datalink (CPRD) GOLD dataset, an anonymised electronic primary care patient database linked with hospital records. Cases were adult patients with incident BD diagnoses between 1st Jan. 2010 and 31st July 2017. These patients were matched by age, sex, and registered general practice to 20 controls without a recorded BD. Annual episode incidence rates were estimated and odds ratios from conditional logistic regression models were reported for recorded health events prior to index (diagnosis) date. Results: There were 2,366 patients with incident BD diagnoses and 47,138 matched control patients (median age 40 years; 60.5% females). Compared with controls, BD cases had higher incidence of diagnosed depressive, psychotic, anxiety and personality disorders recorded and escalating self-harm, up to 10 years before BD diagnosis. Sleep disturbance, substance misuse and mood swings were more frequent among cases than controls. Also, cases had more frequent face-to-face consultations and were more likely to miss multiple scheduled appointments and prescribed three different psychotropic medication classes in a given year. Conclusion: Psychiatric diagnoses, psychotropic prescriptions and health service use patterns might be signals of unreported BD. Recognition of these signals could prompt further investigation for undiagnosed significant psychopathology, leading to timely referral, assessment and initiation of appropriate treatments.
- Author for correspondence
- catharine Morgan
- Email for correspondence
- cathy.morgan@manchester.ac.uk
Code list: res201: alcohol misuse
95 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 1366.00 | Read | Very heavy drinker - >9u/day | diagnostic | res201: alcohol misuse | |||
| 136Q.00 | Read | Very heavy drinker | diagnostic | res201: alcohol misuse | |||
| 136T.00 | Read | harmful alcohol use | diagnostic | res201: alcohol misuse | |||
| 1B1c.00 | Read | Alcohol induced hallucinations | diagnostic | res201: alcohol misuse | |||
| 66e0.00 | Read | alcohol abuse monitoring | diagnostic | res201: alcohol misuse | |||
| 7P22100 | Read | Delivery of rehabilitation for alcohol addiction | diagnostic | res201: alcohol misuse | |||
| 8BA8.00 | Read | Alcohol detoxification | diagnostic | res201: alcohol misuse | |||
| 8CAv.00 | Read | advised to contact primary care alcohol worker | diagnostic | res201: alcohol misuse | |||
| 8G32.00 | Read | Aversion therapy - alcoholism | diagnostic | res201: alcohol misuse | |||
| 8H35.00 | Read | admitted to alcohol detoxification centre | diagnostic | res201: alcohol misuse | |||
| 8HkG.00 | Read | Referral to specialist alcohol treatment service | diagnostic | res201: alcohol misuse | |||
| 8IAF.00 | Read | brief intervention for excessive alcohol consumptn declined | diagnostic | res201: alcohol misuse | |||
| 8IAJ.00 | Read | declined referral to specialist alcohol treatment service | diagnostic | res201: alcohol misuse | |||
| 8IAt.00 | Read | Extended intervention for excessive alcohol consumption declined | diagnostic | res201: alcohol misuse | |||
| 9k1A.00 | Read | Brief intervention for excessive alcohol consumptn completed | diagnostic | res201: alcohol misuse | |||
| 9k1B.00 | Read | Extended intervention for excessive alcohol consumption completed | diagnostic | res201: alcohol misuse | |||
| 9NN2.00 | Read | Under care of community alcohol team | diagnostic | res201: alcohol misuse | |||
| C150500 | Read | Alcohol-induced pseudo-Cushing's syndrome | diagnostic | res201: alcohol misuse | |||
| E01..00 | Read | Alcoholic psychoses | diagnostic | res201: alcohol misuse | |||
| E010.00 | Read | Alcohol withdrawal delirium | diagnostic | res201: alcohol misuse | |||
| E011000 | Read | Korsakov's alcoholic psychosis | diagnostic | res201: alcohol misuse | |||
| E011100 | Read | Korsakov's alcoholic psychosis with peripheral neuritis | diagnostic | res201: alcohol misuse | |||
| E011200 | Read | Wernicke-Korsakov syndrome | diagnostic | res201: alcohol misuse | |||
| E011z00 | Read | Alcohol amnestic syndrome NOS | diagnostic | res201: alcohol misuse | |||
| E012000 | Read | Chronic alcoholic brain syndrome | diagnostic | res201: alcohol misuse | |||
| E012.11 | Read | alcoholic dementia nos | diagnostic | res201: alcohol misuse | |||
| E013.00 | Read | Alcohol withdrawal hallucinosis | diagnostic | res201: alcohol misuse | |||
| E014.00 | Read | pathological alcohol intoxication | diagnostic | res201: alcohol misuse | |||
| E015.00 | Read | Alcoholic paranoia | diagnostic | res201: alcohol misuse | |||
| E01y.00 | Read | Other alcoholic psychosis | diagnostic | res201: alcohol misuse | |||
| E01y000 | Read | Alcohol withdrawal syndrome | diagnostic | res201: alcohol misuse | |||
| E01yz00 | Read | Other alcoholic psychosis NOS | diagnostic | res201: alcohol misuse | |||
| E01z.00 | Read | Alcoholic psychosis NOS | diagnostic | res201: alcohol misuse | |||
| E23..00 | Read | Alcohol dependence syndrome | diagnostic | res201: alcohol misuse | |||
| E230.00 | Read | Acute alcoholic intoxication in alcoholism | diagnostic | res201: alcohol misuse | |||
| E230000 | Read | Acute alcoholic intoxication; unspecified; in alcoholism | diagnostic | res201: alcohol misuse | |||
| E230100 | Read | Continuous acute alcoholic intoxication in alcoholism | diagnostic | res201: alcohol misuse | |||
| E230.11 | Read | alcohol dependence with acute alcoholic intoxication | diagnostic | res201: alcohol misuse | |||
| E230200 | Read | Episodic acute alcoholic intoxication in alcoholism | diagnostic | res201: alcohol misuse | |||
| E230300 | Read | Acute alcoholic intoxication in remission; in alcoholism | diagnostic | res201: alcohol misuse | |||
| E230z00 | Read | Acute alcoholic intoxication in alcoholism NOS | diagnostic | res201: alcohol misuse | |||
| E231.00 | Read | Chronic alcoholism | diagnostic | res201: alcohol misuse | |||
| E231000 | Read | Unspecified chronic alcoholism | diagnostic | res201: alcohol misuse | |||
| E23..11 | Read | Alcoholism | diagnostic | res201: alcohol misuse | |||
| E231100 | Read | Continuous chronic alcoholism | diagnostic | res201: alcohol misuse | |||
| E231200 | Read | Episodic chronic alcoholism | diagnostic | res201: alcohol misuse | |||
| E231300 | Read | Chronic alcoholism in remission | diagnostic | res201: alcohol misuse | |||
| E231z00 | Read | Chronic alcoholism NOS | diagnostic | res201: alcohol misuse | |||
| E23z.00 | Read | Alcohol dependence syndrome NOS | diagnostic | res201: alcohol misuse | |||
| E250300 | Read | nondependent alcohol abuse in remission | diagnostic | res201: alcohol misuse | |||
| Eu10.00 | Read | [X]Mental and behavioural disorders due to use of alcohol | diagnostic | res201: alcohol misuse | |||
| Eu10100 | Read | [x]mental and behav dis due to use of alcohol: harmful use | diagnostic | res201: alcohol misuse | |||
| Eu10200 | Read | [X]Mental and behavioural disorders due to use of alcohol: dependence syndrome | diagnostic | res201: alcohol misuse | |||
| Eu10211 | Read | [x]alcohol addiction | diagnostic | res201: alcohol misuse | |||
| Eu10212 | Read | [x]chronic alcoholism | diagnostic | res201: alcohol misuse | |||
| Eu10300 | Read | [X]Mental and behavioural disorders due to use of alcohol: withdrawal state | diagnostic | res201: alcohol misuse | |||
| Eu10400 | Read | [X]Mental and behavioural disorders due to use of alcohol: withdrawal state with delirium | diagnostic | res201: alcohol misuse | |||
| Eu10411 | Read | [x]delirium tremens; alcohol induced | diagnostic | res201: alcohol misuse | |||
| Eu10500 | Read | [X]Mental and behavioural disorders due to use of alcohol: psychotic disorder | diagnostic | res201: alcohol misuse | |||
| Eu10511 | Read | [X]Alcoholic hallucinosis | diagnostic | res201: alcohol misuse | |||
| Eu10512 | Read | [x]alcoholic jealousy | diagnostic | res201: alcohol misuse | |||
| Eu10513 | Read | [X]Alcoholic paranoia | diagnostic | res201: alcohol misuse | |||
| Eu10514 | Read | [X]Alcoholic psychosis NOS | diagnostic | res201: alcohol misuse | |||
| Eu10600 | Read | [X]Mental and behavioural disorders due to use of alcohol: amnesic syndrome | diagnostic | res201: alcohol misuse | |||
| Eu10611 | Read | [x]korsakov's psychosis; alcohol induced | diagnostic | res201: alcohol misuse | |||
| Eu10700 | Read | [X]Mental and behavioural disorders due to use of alcohol: residual and late-onset psychotic disorde | diagnostic | res201: alcohol misuse | |||
| Eu10711 | Read | [X]Alcoholic dementia NOS | diagnostic | res201: alcohol misuse | |||
| Eu10712 | Read | [X]Chronic alcoholic brain syndrome | diagnostic | res201: alcohol misuse | |||
| Eu10800 | Read | [X]Alcohol withdrawal-induced seizure | diagnostic | res201: alcohol misuse | |||
| Eu10y00 | Read | [X]Mental and behavioural disorders due to use of alcohol: other mental and behavioural disorders | diagnostic | res201: alcohol misuse | |||
| Eu10z00 | Read | [X]Mental and behavioural disorders due to use of alcohol: unspecified mental and behavioural disord | diagnostic | res201: alcohol misuse | |||
| Eu11.00 | Read | Referral to community alcohol team | diagnostic | res201: alcohol misuse | |||
| F11x000 | Read | Cerebral degeneration due to alcoholism | diagnostic | res201: alcohol misuse | |||
| F11x011 | Read | Alcoholic encephalopathy | diagnostic | res201: alcohol misuse | |||
| F144000 | Read | Cerebellar ataxia due to alcoholism | diagnostic | res201: alcohol misuse | |||
| F25B.00 | Read | Alcohol-induced epilepsy | diagnostic | res201: alcohol misuse | |||
| F375.00 | Read | Alcoholic polyneuropathy | diagnostic | res201: alcohol misuse | |||
| F394100 | Read | Alcoholic myopathy | diagnostic | res201: alcohol misuse | |||
| G555.00 | Read | Alcoholic cardiomyopathy | diagnostic | res201: alcohol misuse | |||
| G852300 | Read | Oesophageal varices in alcoholic cirrhosis of the liver | diagnostic | res201: alcohol misuse | |||
| J610.00 | Read | Alcoholic fatty liver | diagnostic | res201: alcohol misuse | |||
| J611.00 | Read | Acute alcoholic hepatitis | diagnostic | res201: alcohol misuse | |||
| J612.00 | Read | Alcoholic cirrhosis of liver | diagnostic | res201: alcohol misuse | |||
| J612000 | Read | Alcoholic fibrosis and sclerosis of liver | diagnostic | res201: alcohol misuse | |||
| J613.00 | Read | Alcoholic liver damage unspecified | diagnostic | res201: alcohol misuse | |||
| J613000 | Read | Alcoholic hepatic failure | diagnostic | res201: alcohol misuse | |||
| J617.00 | Read | Alcoholic hepatitis | diagnostic | res201: alcohol misuse | |||
| J617000 | Read | Chronic alcoholic hepatitis | diagnostic | res201: alcohol misuse | |||
| J671000 | Read | Alcohol-induced chronic pancreatitis | diagnostic | res201: alcohol misuse | |||
| U60H300 | Read | [X]Alcohol deterrents causing adverse effects in therapeutic use | diagnostic | res201: alcohol misuse | |||
| U60H311 | Read | [X] Adverse reaction to alcohol deterrents | diagnostic | res201: alcohol misuse | |||
| Z191.00 | Read | Alcohol detoxification | diagnostic | res201: alcohol misuse | |||
| Z191100 | Read | alcohol withdrawal regime | diagnostic | res201: alcohol misuse | |||
| Z191211 | Read | alcohol reduction programme | diagnostic | res201: alcohol misuse | |||
| ZR1E.11 | Read | ads - alcohol dependence scale | diagnostic | res201: alcohol misuse |
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