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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: Bipolar disorder
96 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 1S42.00 | Read | manic mood | diagnostic | res201: Bipolar disorder | |||
| E110.00 | Read | manic disorder, single episode | diagnostic | res201: Bipolar disorder | |||
| E110000 | Read | single manic episode, unspecified | diagnostic | res201: Bipolar disorder | |||
| E110100 | Read | single manic episode, mild | diagnostic | res201: Bipolar disorder | |||
| E110.11 | Read | hypomanic psychoses | diagnostic | res201: Bipolar disorder | |||
| E110200 | Read | single manic episode, moderate | diagnostic | res201: Bipolar disorder | |||
| E110300 | Read | single manic episode, severe without mention of psychosis | diagnostic | res201: Bipolar disorder | |||
| E110400 | Read | single manic episode, severe, with psychosis | diagnostic | res201: Bipolar disorder | |||
| E110500 | Read | Single manic episode in partial or unspecified remission | diagnostic | res201: Bipolar disorder | |||
| E110600 | Read | single manic episode in full remission | diagnostic | res201: Bipolar disorder | |||
| E110z00 | Read | manic disorder, single episode nos | diagnostic | res201: Bipolar disorder | |||
| E111.00 | Read | recurrent manic episodes | diagnostic | res201: Bipolar disorder | |||
| E111000 | Read | recurrent manic episodes, unspecified | diagnostic | res201: Bipolar disorder | |||
| E11..11 | Read | bipolar psychoses | diagnostic | res201: Bipolar disorder | |||
| E111100 | Read | recurrent manic episodes, mild | diagnostic | res201: Bipolar disorder | |||
| E111200 | Read | recurrent manic episodes, moderate | diagnostic | res201: Bipolar disorder | |||
| E11..13 | Read | manic psychoses | diagnostic | res201: Bipolar disorder | |||
| E111300 | Read | recurrent manic episodes, severe without mention psychosis | diagnostic | res201: Bipolar disorder | |||
| E111400 | Read | recurrent manic episodes, severe, with psychosis | diagnostic | res201: Bipolar disorder | |||
| E111500 | Read | recurrent manic episodes, partial or unspecified remission | diagnostic | res201: Bipolar disorder | |||
| E111600 | Read | recurrent manic episodes, in full remission | diagnostic | res201: Bipolar disorder | |||
| E111z00 | Read | recurrent manic episode nos | diagnostic | res201: Bipolar disorder | |||
| E114.00 | Read | bipolar affective disorder, currently manic | diagnostic | res201: Bipolar disorder | |||
| E114000 | Read | bipolar affective disorder, currently manic, unspecified | diagnostic | res201: Bipolar disorder | |||
| E114100 | Read | bipolar affective disorder, currently manic, mild | diagnostic | res201: Bipolar disorder | |||
| E114.11 | Read | manic-depressive - now manic | diagnostic | res201: Bipolar disorder | |||
| E114200 | Read | bipolar affective disorder, currently manic, moderate | diagnostic | res201: Bipolar disorder | |||
| E114300 | Read | bipolar affect disord, currently manic, severe, no psychosis | diagnostic | res201: Bipolar disorder | |||
| E114400 | Read | bipolar affect disord, currently manic,severe with psychosis | diagnostic | res201: Bipolar disorder | |||
| E114500 | Read | bipolar affect disord,currently manic, part/unspec remission | diagnostic | res201: Bipolar disorder | |||
| E114600 | Read | bipolar affective disorder, currently manic, full remission | diagnostic | res201: Bipolar disorder | |||
| E114z00 | Read | bipolar affective disorder, currently manic, nos | diagnostic | res201: Bipolar disorder | |||
| E115.00 | Read | bipolar affective disorder, currently depressed | diagnostic | res201: Bipolar disorder | |||
| E115000 | Read | bipolar affective disorder, currently depressed, unspecified | diagnostic | res201: Bipolar disorder | |||
| E115100 | Read | bipolar affective disorder, currently depressed, mild | diagnostic | res201: Bipolar disorder | |||
| E115.11 | Read | manic-depressive - now depressed | diagnostic | res201: Bipolar disorder | |||
| E115200 | Read | bipolar affective disorder, currently depressed, moderate | diagnostic | res201: Bipolar disorder | |||
| E115300 | Read | bipolar affect disord, now depressed, severe, no psychosis | diagnostic | res201: Bipolar disorder | |||
| E115400 | Read | bipolar affect disord, now depressed, severe with psychosis | diagnostic | res201: Bipolar disorder | |||
| E115500 | Read | bipolar affect disord, now depressed, part/unspec remission | diagnostic | res201: Bipolar disorder | |||
| E115600 | Read | bipolar affective disorder, now depressed, in full remission | diagnostic | res201: Bipolar disorder | |||
| E115z00 | Read | bipolar affective disorder, currently depressed, nos | diagnostic | res201: Bipolar disorder | |||
| E116.00 | Read | mixed bipolar affective disorder | diagnostic | res201: Bipolar disorder | |||
| E116000 | Read | mixed bipolar affective disorder, unspecified | diagnostic | res201: Bipolar disorder | |||
| E116100 | Read | mixed bipolar affective disorder, mild | diagnostic | res201: Bipolar disorder | |||
| E116200 | Read | mixed bipolar affective disorder, moderate | diagnostic | res201: Bipolar disorder | |||
| E116300 | Read | mixed bipolar affective disorder, severe, without psychosis | diagnostic | res201: Bipolar disorder | |||
| E116400 | Read | mixed bipolar affective disorder, severe, with psychosis | diagnostic | res201: Bipolar disorder | |||
| E116500 | Read | mixed bipolar affective disorder, partial/unspec remission | diagnostic | res201: Bipolar disorder | |||
| E116600 | Read | mixed bipolar affective disorder, in full remission | diagnostic | res201: Bipolar disorder | |||
| E116z00 | Read | mixed bipolar affective disorder, nos | diagnostic | res201: Bipolar disorder | |||
| E117.00 | Read | unspecified bipolar affective disorder | diagnostic | res201: Bipolar disorder | |||
| E117000 | Read | unspecified bipolar affective disorder, unspecified | diagnostic | res201: Bipolar disorder | |||
| E117100 | Read | unspecified bipolar affective disorder, mild | diagnostic | res201: Bipolar disorder | |||
| E117200 | Read | unspecified bipolar affective disorder, moderate | diagnostic | res201: Bipolar disorder | |||
| E117300 | Read | unspecified bipolar affective disorder, severe, no psychosis | diagnostic | res201: Bipolar disorder | |||
| E117400 | Read | unspecified bipolar affective disorder,severe with psychosis | diagnostic | res201: Bipolar disorder | |||
| E117500 | Read | unspecified bipolar affect disord, partial/unspec remission | diagnostic | res201: Bipolar disorder | |||
| E117600 | Read | unspecified bipolar affective disorder, in full remission | diagnostic | res201: Bipolar disorder | |||
| E117z00 | Read | unspecified bipolar affective disorder, nos | diagnostic | res201: Bipolar disorder | |||
| E11y.00 | Read | other and unspecified manic-depressive psychoses | diagnostic | res201: Bipolar disorder | |||
| E11y000 | Read | unspecified manic-depressive psychoses | diagnostic | res201: Bipolar disorder | |||
| E11y100 | Read | atypical manic disorder | diagnostic | res201: Bipolar disorder | |||
| E11y300 | Read | other mixed manic-depressive psychoses | diagnostic | res201: Bipolar disorder | |||
| E11yz00 | Read | other and unspecified manic-depressive psychoses nos | diagnostic | res201: Bipolar disorder | |||
| Eu30.00 | Read | [x]manic episode | diagnostic | res201: Bipolar disorder | |||
| Eu30000 | Read | [x]hypomania | diagnostic | res201: Bipolar disorder | |||
| Eu30100 | Read | [x]mania without psychotic symptoms | diagnostic | res201: Bipolar disorder | |||
| Eu30.11 | Read | [x]bipolar disorder, single manic episode | diagnostic | res201: Bipolar disorder | |||
| Eu30200 | Read | [x]mania with psychotic symptoms | diagnostic | res201: Bipolar disorder | |||
| Eu30211 | Read | [x]mania with mood-congruent psychotic symptoms | diagnostic | res201: Bipolar disorder | |||
| Eu30212 | Read | [x]mania with mood-incongruent psychotic symptoms | diagnostic | res201: Bipolar disorder | |||
| Eu30y00 | Read | [x]other manic episodes | diagnostic | res201: Bipolar disorder | |||
| Eu30z00 | Read | [x]manic episode, unspecified | diagnostic | res201: Bipolar disorder | |||
| Eu30z11 | Read | [x]mania nos | diagnostic | res201: Bipolar disorder | |||
| Eu31.00 | Read | [x]bipolar affective disorder | diagnostic | res201: Bipolar disorder | |||
| Eu31000 | Read | [x]bipolar affective disorder, current episode hypomanic | diagnostic | res201: Bipolar disorder | |||
| Eu31100 | Read | [x]bipolar affect disorder cur epi manic wout psychotic symp | diagnostic | res201: Bipolar disorder | |||
| Eu31.11 | Read | [x]manic-depressive illness | diagnostic | res201: Bipolar disorder | |||
| Eu31.12 | Read | [x]manic-depressive psychosis | diagnostic | res201: Bipolar disorder | |||
| Eu31.13 | Read | [x]manic-depressive reaction | diagnostic | res201: Bipolar disorder | |||
| Eu31200 | Read | [x]bipolar affect disorder cur epi manic with psychotic symp | diagnostic | res201: Bipolar disorder | |||
| Eu31300 | Read | [x]bipolar affect disorder cur epi mild or moderate depressn | diagnostic | res201: Bipolar disorder | |||
| Eu31400 | Read | [x]bipol aff disord, curr epis sev depress, no psychot symp | diagnostic | res201: Bipolar disorder | |||
| Eu31500 | Read | [x]bipolar affect dis cur epi severe depres with psyc symp | diagnostic | res201: Bipolar disorder | |||
| Eu31600 | Read | [x]bipolar affective disorder, current episode mixed | diagnostic | res201: Bipolar disorder | |||
| Eu31700 | Read | [x]bipolar affective disorder, currently in remission | diagnostic | res201: Bipolar disorder | |||
| Eu31800 | Read | [x]bipolar affective disorder type i | diagnostic | res201: Bipolar disorder | |||
| Eu31900 | Read | [x]bipolar affective disorder type ii | diagnostic | res201: Bipolar disorder | |||
| Eu31911 | Read | [x]bipolar ii disorder | diagnostic | res201: Bipolar disorder | |||
| Eu31y00 | Read | [x]other bipolar affective disorders | diagnostic | res201: Bipolar disorder | |||
| Eu31y11 | Read | [x]bipolar ii disorder | diagnostic | res201: Bipolar disorder | |||
| Eu31y12 | Read | [x]recurrent manic episodes | diagnostic | res201: Bipolar disorder | |||
| Eu31z00 | Read | [x]bipolar affective disorder, unspecified | diagnostic | res201: Bipolar disorder | |||
| Eu33213 | Read | [x]Manic-depress psychosis, depressed, no psychotic symptoms | diagnostic | res201: Bipolar disorder | |||
| Eu33312 | Read | [x]Manic-depress psychosis, depressed type+psychotic symptoms | diagnostic | res201: Bipolar disorder |
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