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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: depression

145 codes in list

Code Coding system Description Entity type List name
1B17.00 Read Depressed diagnostic res201: depression
1B17.11 Read C/O - feeling depressed diagnostic res201: depression
1B17.12 Read C/O - feeling unhappy diagnostic res201: depression
1B1U.00 Read Symptoms of depression diagnostic res201: depression
1B1U.11 Read Depressive symptoms diagnostic res201: depression
1BI..00 Read Blunted affect diagnostic res201: depression
1BP0.00 Read Loss of interest in previously enjoyable activity diagnostic res201: depression
1BQ..00 Read Loss of capacity for enjoyment diagnostic res201: depression
1BT..00 Read Depressed mood diagnostic res201: depression
1BT..11 Read Low mood diagnostic res201: depression
1BT..12 Read Sad mood diagnostic res201: depression
1BU..00 Read Loss of hope for the future diagnostic res201: depression
2257.00 Read O/E - depressed diagnostic res201: depression
62T1.00 Read Puerperal depression diagnostic res201: depression
6G00.00 Read Postnatal depression counselling diagnostic res201: depression
8BK0.00 Read Depression management programme diagnostic res201: depression
8CAa.00 Read Patient given advice about management of depression diagnostic res201: depression
8HHq.00 Read Referral for guided self-help for depression diagnostic res201: depression
9H90.00 Read Depression annual review diagnostic res201: depression
9H91.00 Read Depression medication review diagnostic res201: depression
9H92.00 Read Depression interim review diagnostic res201: depression
9HA0.00 Read On depression register diagnostic res201: depression
9k4..00 Read Depression - enhanced services administration diagnostic res201: depression
9k40.00 Read Depression - enhanced service completed diagnostic res201: depression
9kQ..00 Read On full dose long term treatment depression - enh serv admin diagnostic res201: depression
9Ov..00 Read Depression monitoring administration diagnostic res201: depression
9Ov0.00 Read Depression monitoring first letter diagnostic res201: depression
9Ov1.00 Read Depression monitoring second letter diagnostic res201: depression
9Ov2.00 Read Depression monitoring third letter diagnostic res201: depression
9Ov3.00 Read Depression monitoring verbal invite diagnostic res201: depression
9Ov4.00 Read Depression monitoring telephone invite diagnostic res201: depression
E001300 Read Presenile dementia with depression diagnostic res201: depression
E002100 Read Senile dementia with depression diagnostic res201: depression
E004300 Read Arteriosclerotic dementia with depression diagnostic res201: depression
E11..12 Read Depressive psychoses diagnostic res201: depression
E112.00 Read Single major depressive episode diagnostic res201: depression
E112000 Read Single major depressive episode, unspecified diagnostic res201: depression
E112100 Read Single major depressive episode, mild diagnostic res201: depression
E112.11 Read Agitated depression diagnostic res201: depression
E112.12 Read Endogenous depression first episode diagnostic res201: depression
E112.13 Read Endogenous depression first episode diagnostic res201: depression
E112.14 Read Endogenous depression diagnostic res201: depression
E112200 Read Single major depressive episode, moderate diagnostic res201: depression
E112300 Read Single major depressive episode, severe, without psychosis diagnostic res201: depression
E112400 Read Single major depressive episode, severe, with psychosis diagnostic res201: depression
E112500 Read Single major depressive episode, partial or unspec remission diagnostic res201: depression
E112z00 Read Single major depressive episode NOS diagnostic res201: depression
E113.00 Read Recurrent major depressive episode diagnostic res201: depression
E113000 Read Recurrent major depressive episodes, unspecified diagnostic res201: depression
E113100 Read Recurrent major depressive episodes, mild diagnostic res201: depression
E113.11 Read Endogenous depression - recurrent diagnostic res201: depression
E113200 Read Recurrent major depressive episodes, moderate diagnostic res201: depression
E113300 Read Recurrent major depressive episodes, severe, no psychosis diagnostic res201: depression
E113400 Read Recurrent major depressive episodes, severe, with psychosis diagnostic res201: depression
E113500 Read Recurrent major depressive episodes,partial/unspec remission diagnostic res201: depression
E113700 Read Recurrent depression diagnostic res201: depression
E113z00 Read Recurrent major depressive episode NOS diagnostic res201: depression
E118.00 Read Seasonal affective disorder diagnostic res201: depression
E11y200 Read Atypical depressive disorder diagnostic res201: depression
E11z200 Read Masked depression diagnostic res201: depression
E130.00 Read Reactive depressive psychosis diagnostic res201: depression
E130.11 Read Psychotic reactive depression diagnostic res201: depression
E135.00 Read Agitated depression diagnostic res201: depression
E200300 Read Anxiety with depression diagnostic res201: depression
E204.00 Read Neurotic depression reactive type diagnostic res201: depression
E204.11 Read Postnatal depression diagnostic res201: depression
E290.00 Read Brief depressive reaction diagnostic res201: depression
E290z00 Read Brief depressive reaction NOS diagnostic res201: depression
E291.00 Read Prolonged depressive reaction diagnostic res201: depression
E2B..00 Read Depressive disorder NEC diagnostic res201: depression
E2B0.00 Read Postviral depression diagnostic res201: depression
E2B1.00 Read Chronic depression diagnostic res201: depression
Eu20400 Read [X]Post-schizophrenic depression diagnostic res201: depression
Eu3..00 Read [X]Mood - affective disorders diagnostic res201: depression
Eu32.00 Read [X]Depressive episode diagnostic res201: depression
Eu32000 Read [X]Mild depressive episode diagnostic res201: depression
Eu32100 Read [X]Moderate depressive episode diagnostic res201: depression
Eu32.11 Read [X]Single episode of depressive reaction diagnostic res201: depression
Eu32.12 Read [X]Single episode of psychogenic depression diagnostic res201: depression
Eu32.13 Read [X]Single episode of reactive depression diagnostic res201: depression
Eu32200 Read [X]Severe depressive episode without psychotic symptoms diagnostic res201: depression
Eu32211 Read [X]Single episode agitated depressn w'out psychotic symptoms diagnostic res201: depression
Eu32212 Read [X]Single episode major depression w'out psychotic symptoms diagnostic res201: depression
Eu32213 Read [X]Single episode vital depression w'out psychotic symptoms diagnostic res201: depression
Eu32300 Read [X]Severe depressive episode with psychotic symptoms diagnostic res201: depression
Eu32311 Read [X]Single episode of major depression and psychotic symptoms diagnostic res201: depression
Eu32312 Read [X]Single episode of psychogenic depressive psychosis diagnostic res201: depression
Eu32313 Read [X]Single episode of psychotic depression diagnostic res201: depression
Eu32314 Read [X]Single episode of reactive depressive psychosis diagnostic res201: depression
Eu32400 Read [X]Mild depression diagnostic res201: depression
Eu32500 Read [X]Major depression, mild diagnostic res201: depression
Eu32600 Read [X]Major depression, moderately severe diagnostic res201: depression
Eu32700 Read [X]Major depression, severe without psychotic symptoms diagnostic res201: depression
Eu32800 Read [X]Major depression, severe with psychotic symptoms diagnostic res201: depression
Eu32900 Read [X]Single major depr ep, severe with psych, psych in remiss diagnostic res201: depression
Eu32A00 Read [X]Recurr major depr ep, severe with psych, psych in remiss diagnostic res201: depression
Eu32B00 Read [X]Antenatal depression diagnostic res201: depression
Eu32y00 Read [X]Other depressive episodes diagnostic res201: depression
Eu32y11 Read [X]Atypical depression diagnostic res201: depression
Eu32y12 Read [X]Single episode of masked depression NOS diagnostic res201: depression
Eu32z00 Read [X]Depressive episode, unspecified diagnostic res201: depression
Eu32z11 Read [X]Depression NOS diagnostic res201: depression
Eu32z12 Read [X]Depressive disorder NOS diagnostic res201: depression
Eu32z13 Read [X]Prolonged single episode of reactive depression diagnostic res201: depression
Eu32z14 Read [X] Reactive depression NOS diagnostic res201: depression
Eu33.00 Read [X]Recurrent depressive disorder diagnostic res201: depression
Eu33000 Read [X]Recurrent depressive disorder, current episode mild diagnostic res201: depression
Eu33100 Read [X]Recurrent depressive disorder, current episode moderate diagnostic res201: depression
Eu33.11 Read [X]Recurrent episodes of depressive reaction diagnostic res201: depression
Eu33.12 Read [X]Recurrent episodes of psychogenic depression diagnostic res201: depression
Eu33.13 Read [X]Recurrent episodes of reactive depression diagnostic res201: depression
Eu33.14 Read [X]Seasonal depressive disorder diagnostic res201: depression
Eu33.15 Read [X]SAD - Seasonal affective disorder diagnostic res201: depression
Eu33200 Read [X]Recurr depress disorder cur epi severe without psyc sympt diagnostic res201: depression
Eu33211 Read [X]Endogenous depression without psychotic symptoms diagnostic res201: depression
Eu33212 Read [X]Major depression, recurrent without psychotic symptoms diagnostic res201: depression
Eu33214 Read [X]Vital depression, recurrent without psychotic symptoms diagnostic res201: depression
Eu33300 Read [X]Recurrent depress disorder cur epi severe with psyc symp diagnostic res201: depression
Eu33311 Read [X]Endogenous depression with psychotic symptoms diagnostic res201: depression
Eu33313 Read [X]Recurr severe episodes/major depression+psychotic symptom diagnostic res201: depression
Eu33314 Read [X]Recurr severe episodes/psychogenic depressive psychosis diagnostic res201: depression
Eu33315 Read [X]Recurrent severe episodes of psychotic depression diagnostic res201: depression
Eu33316 Read [X]Recurrent severe episodes/reactive depressive psychosis diagnostic res201: depression
Eu33y00 Read [X]Other recurrent depressive disorders diagnostic res201: depression
Eu33z00 Read [X]Recurrent depressive disorder, unspecified diagnostic res201: depression
Eu33z11 Read [X]Monopolar depression NOS diagnostic res201: depression
Eu34.00 Read [X]Persistent mood affective disorders diagnostic res201: depression
Eu34100 Read [X]Dysthymia diagnostic res201: depression
Eu34111 Read [X]Depressive neurosis diagnostic res201: depression
Eu34113 Read [X]Neurotic depression diagnostic res201: depression
Eu34114 Read [X]Persistant anxiety depression diagnostic res201: depression
Eu34y00 Read [X]Other persistent mood affective disorders diagnostic res201: depression
Eu34z00 Read [X]Persistent mood affective disorder, unspecified diagnostic res201: depression
Eu3y.00 Read [X]Other mood affective disorders diagnostic res201: depression
Eu3y000 Read [X]Other single mood affective disorders diagnostic res201: depression
Eu3y100 Read [X]Other recurrent mood affective disorders diagnostic res201: depression
Eu3y111 Read [X]Recurrent brief depressive episodes diagnostic res201: depression
Eu3yy00 Read [X]Other specified mood affective disorders diagnostic res201: depression
Eu3z.00 Read [X]Unspecified mood affective disorder diagnostic res201: depression
Eu41200 Read [X]Mixed anxiety and depressive disorder diagnostic res201: depression
Eu41211 Read [X]Mild anxiety depression diagnostic res201: depression
Eu53011 Read [X]Postnatal depression NOS diagnostic res201: depression
Eu53012 Read [X]Postpartum depression NOS diagnostic res201: depression
Eu92000 Read [X]Depressive conduct disorder diagnostic res201: depression
R007z13 Read [D]Postoperative depression diagnostic res201: depression

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