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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: drug misuse
185 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 13c..00 | Read | Drug user | diagnostic | res201: drug misuse | |||
| 13c0.00 | Read | Injecting drug user | diagnostic | res201: drug misuse | |||
| 13c1.00 | Read | Intravenous drug user | diagnostic | res201: drug misuse | |||
| 13c3.00 | Read | Intramuscular drug user | diagnostic | res201: drug misuse | |||
| 13c4.00 | Read | Intranasal drug user | diagnostic | res201: drug misuse | |||
| 13c5.00 | Read | Substance misuse increased | diagnostic | res201: drug misuse | |||
| 13c6.00 | Read | Substance misuse decreased | diagnostic | res201: drug misuse | |||
| 13c7.00 | Read | Current drug user | diagnostic | res201: drug misuse | |||
| 13c8.00 | Read | Reduced drugs misuse | diagnostic | res201: drug misuse | |||
| 13c9.00 | Read | Subcutaneous drug user | diagnostic | res201: drug misuse | |||
| 13cA.00 | Read | Smokes drugs | diagnostic | res201: drug misuse | |||
| 13cB.00 | Read | Misuses drugs orally | diagnostic | res201: drug misuse | |||
| 13cC.00 | Read | Continuous use of drugs | diagnostic | res201: drug misuse | |||
| 13cD.00 | Read | Episodic use of drugs | diagnostic | res201: drug misuse | |||
| 13cE.00 | Read | Prolonged high dose use of cannabis | diagnostic | res201: drug misuse | |||
| 13cF.00 | Read | Preoccupied with substance misuse | diagnostic | res201: drug misuse | |||
| 13cH.00 | Read | Persistent substance misuse | diagnostic | res201: drug misuse | |||
| 13cM.00 | Read | Substance misuse | diagnostic | res201: drug misuse | |||
| 146C.00 | Read | Failed heroin detoxification | diagnostic | res201: drug misuse | |||
| 1TE..00 | Read | Uses heroin on top of substitution therapy | diagnostic | res201: drug misuse | |||
| 1V...00 | Read | Drug misuse behaviour | diagnostic | res201: drug misuse | |||
| 1V0..00 | Read | Misuses drugs | diagnostic | res201: drug misuse | |||
| 1V00.00 | Read | Occasional drug user | diagnostic | res201: drug misuse | |||
| 1V01.00 | Read | Long-term drug misuser | diagnostic | res201: drug misuse | |||
| 1V02.00 | Read | Poly-drug misuser | diagnostic | res201: drug misuse | |||
| 1V07.00 | Read | Notified addict | diagnostic | res201: drug misuse | |||
| 1V08.00 | Read | Smokes drugs in cigarette form | diagnostic | res201: drug misuse | |||
| 1V09.00 | Read | Smokes drugs through a pipe | diagnostic | res201: drug misuse | |||
| 1V0A.00 | Read | Chases the dragon | diagnostic | res201: drug misuse | |||
| 1V0B.00 | Read | Sniffs drugs | diagnostic | res201: drug misuse | |||
| 1V0C.00 | Read | Drug addict | diagnostic | res201: drug misuse | |||
| 1V0E.00 | Read | Health problem secondary to drug misuse | diagnostic | res201: drug misuse | |||
| 1V22.00 | Read | Age at starting drug misuse | diagnostic | res201: drug misuse | |||
| 1V26.00 | Read | Misused drugs in past | diagnostic | res201: drug misuse | |||
| 1V35.00 | Read | Shares drug equipment | diagnostic | res201: drug misuse | |||
| 1V38.00 | Read | Sharing of drug injecting equipment | diagnostic | res201: drug misuse | |||
| 1V6..00 | Read | Drug-related offending behaviour | diagnostic | res201: drug misuse | |||
| 1V63.00 | Read | Possession of drugs | diagnostic | res201: drug misuse | |||
| 1V64.00 | Read | Illicit drug use | diagnostic | res201: drug misuse | |||
| 1V65.00 | Read | Heroin misuse | diagnostic | res201: drug misuse | |||
| 1V66.00 | Read | Ecstasy misuse | diagnostic | res201: drug misuse | |||
| 677T.00 | Read | Substance misuse structured counselling | diagnostic | res201: drug misuse | |||
| 7P22000 | Read | Delivery of rehabilitation for drug addiction | diagnostic | res201: drug misuse | |||
| 8AA..00 | Read | Drug abuse monitoring | diagnostic | res201: drug misuse | |||
| 8B23.00 | Read | Drug addiction therapy | diagnostic | res201: drug misuse | |||
| 8B23.11 | Read | Drug addictn therap-methadone | diagnostic | res201: drug misuse | |||
| 8B2N.00 | Read | Drug addiction detoxification therapy - methadone | diagnostic | res201: drug misuse | |||
| 8B2P.00 | Read | Drug addiction maintenance therapy - methadone | diagnostic | res201: drug misuse | |||
| 8B2Q.00 | Read | Drug addiction maintenance therapy - buprenorphine | diagnostic | res201: drug misuse | |||
| 8B2R.00 | Read | Drug addiction detoxification therapy - buprenorphine | diagnostic | res201: drug misuse | |||
| 8B2S.00 | Read | Opioid agonist substitution therapy | diagnostic | res201: drug misuse | |||
| 8B2T.00 | Read | Opioid antagonist therapy | diagnostic | res201: drug misuse | |||
| 8BA9.00 | Read | Detoxification dependence drug | diagnostic | res201: drug misuse | |||
| 8BAd.00 | Read | Opiate dependence detoxification | diagnostic | res201: drug misuse | |||
| 8BAo.00 | Read | Benzodiazepine dependence detoxification | diagnostic | res201: drug misuse | |||
| 8BAW.00 | Read | Drug dependence self detoxification | diagnostic | res201: drug misuse | |||
| 8BAX.00 | Read | Drug dependence home detoxification | diagnostic | res201: drug misuse | |||
| 8H7x.00 | Read | Referral to drug abuse counsellor | diagnostic | res201: drug misuse | |||
| 8Hh1.00 | Read | Self referral to substance misuse service | diagnostic | res201: drug misuse | |||
| 8HkF.00 | Read | Referral to substance misuse service | diagnostic | res201: drug misuse | |||
| 8Hq..00 | Read | Admission to substance misuse detoxification centre | diagnostic | res201: drug misuse | |||
| 9G2..00 | Read | Drug addiction notification | diagnostic | res201: drug misuse | |||
| 9G21.00 | Read | Drug addict notific to CMO | diagnostic | res201: drug misuse | |||
| 9G2..11 | Read | Drug addict notific admin | diagnostic | res201: drug misuse | |||
| 9G22.00 | Read | Drug addict re-notific due | diagnostic | res201: drug misuse | |||
| 9G23.00 | Read | Drug addict re-notif to CMO | diagnostic | res201: drug misuse | |||
| 9G24.00 | Read | Drug addict-notify local SMR22 | diagnostic | res201: drug misuse | |||
| 9G2Z.00 | Read | Drug addiction notif NOS | diagnostic | res201: drug misuse | |||
| 9HC..00 | Read | Substance misuse monitoring | diagnostic | res201: drug misuse | |||
| 9HC1.00 | Read | Follow up substance misuse assessment | diagnostic | res201: drug misuse | |||
| 9HC2.00 | Read | Substance misuse clinical management plan agreed | diagnostic | res201: drug misuse | |||
| 9HC3.00 | Read | Substance misuse clinical management plan reviewed | diagnostic | res201: drug misuse | |||
| 9HC4.00 | Read | Substance misuse treatment withdrawn | diagnostic | res201: drug misuse | |||
| 9HC5.00 | Read | Substance misuse treatment programme completed | diagnostic | res201: drug misuse | |||
| 9HC6.00 | Read | Substance misuse treatment declined | diagnostic | res201: drug misuse | |||
| 9K4..00 | Read | SMR25a drug misuse initial assessment form | diagnostic | res201: drug misuse | |||
| 9k5..00 | Read | Drug misuse - enhanced services administration | diagnostic | res201: drug misuse | |||
| 9k50.00 | Read | Drug misuse - enhanced service completed | diagnostic | res201: drug misuse | |||
| 9k51.00 | Read | Shared care drug misuse treatment - enhanced services admin | diagnostic | res201: drug misuse | |||
| 9k51.11 | Read | Shared care drug misuse treatment | diagnostic | res201: drug misuse | |||
| 9k52.00 | Read | Drug misuse treatment primary care - enhanced services admin | diagnostic | res201: drug misuse | |||
| 9k53.00 | Read | Pharmacy attended for drug misuse - enhanced services admin | diagnostic | res201: drug misuse | |||
| 9kS..00 | Read | Drug misuse assessment declined - enhanced services administ | diagnostic | res201: drug misuse | |||
| 9N1yJ00 | Read | Seen in drug misuse clinic | diagnostic | res201: drug misuse | |||
| 9N4i.00 | Read | DNA - Did not attend substance misuse clinic | diagnostic | res201: drug misuse | |||
| 9NdN.00 | Read | Declined consent for notification of drug misuse | diagnostic | res201: drug misuse | |||
| 9No5.00 | Read | Seen in substance misuse clinic | diagnostic | res201: drug misuse | |||
| 9s...00 | Read | Drug misuse clinic administration | diagnostic | res201: drug misuse | |||
| E020.00 | Read | Drug withdrawal syndrome | diagnostic | res201: drug misuse | |||
| E24..00 | Read | Drug dependence | diagnostic | res201: drug misuse | |||
| E240.00 | Read | Opioid type drug dependence | diagnostic | res201: drug misuse | |||
| E240000 | Read | Unspecified opioid dependence | diagnostic | res201: drug misuse | |||
| E240100 | Read | Continuous opioid dependence | diagnostic | res201: drug misuse | |||
| E240.11 | Read | Heroin dependence | diagnostic | res201: drug misuse | |||
| E240.12 | Read | Methadone dependence | diagnostic | res201: drug misuse | |||
| E240.13 | Read | Morphine dependence | diagnostic | res201: drug misuse | |||
| E240.14 | Read | Opium dependence | diagnostic | res201: drug misuse | |||
| E240200 | Read | Episodic opioid dependence | diagnostic | res201: drug misuse | |||
| E240300 | Read | Opioid dependence in remission | diagnostic | res201: drug misuse | |||
| E240z00 | Read | Opioid drug dependence NOS | diagnostic | res201: drug misuse | |||
| E24..11 | Read | Drug addiction | diagnostic | res201: drug misuse | |||
| E241.15 | Read | Librium dependence | diagnostic | res201: drug misuse | |||
| E242.00 | Read | Cocaine type drug dependence | diagnostic | res201: drug misuse | |||
| E242000 | Read | Cocaine dependence; unspecified | diagnostic | res201: drug misuse | |||
| E242100 | Read | Cocaine dependence; continuous | diagnostic | res201: drug misuse | |||
| E242200 | Read | Cocaine dependence; episodic | diagnostic | res201: drug misuse | |||
| E242300 | Read | Cocaine dependence in remission | diagnostic | res201: drug misuse | |||
| E242z00 | Read | Cocaine drug dependence NOS | diagnostic | res201: drug misuse | |||
| E243.00 | Read | Cannabis type drug dependence | diagnostic | res201: drug misuse | |||
| E243000 | Read | Cannabis dependence; unspecified | diagnostic | res201: drug misuse | |||
| E243100 | Read | Cannabis dependence; continuous | diagnostic | res201: drug misuse | |||
| E243.11 | Read | Hashish dependence | diagnostic | res201: drug misuse | |||
| E243.12 | Read | Hemp dependence | diagnostic | res201: drug misuse | |||
| E243.13 | Read | Marihuana dependence | diagnostic | res201: drug misuse | |||
| E243200 | Read | Cannabis dependence; episodic | diagnostic | res201: drug misuse | |||
| E243300 | Read | Cannabis dependence in remission | diagnostic | res201: drug misuse | |||
| E243z00 | Read | Cannabis drug dependence NOS | diagnostic | res201: drug misuse | |||
| E244.00 | Read | Amphetamine or other psychostimulant dependence | diagnostic | res201: drug misuse | |||
| E244000 | Read | Amphetamine or psychostimulant dependence; unspecified | diagnostic | res201: drug misuse | |||
| E244011 | Read | Amfetamine or psychostimulant dependence; unspecified | diagnostic | res201: drug misuse | |||
| E244100 | Read | Amphetamine or psychostimulant dependence; continuous | diagnostic | res201: drug misuse | |||
| E244.11 | Read | Psychostimulant dependence | diagnostic | res201: drug misuse | |||
| E244.12 | Read | Stimulant dependence | diagnostic | res201: drug misuse | |||
| E244200 | Read | Amphetamine or psychostimulant dependence; episodic | diagnostic | res201: drug misuse | |||
| E244300 | Read | Amphetamine or psychostimulant dependence in remission | diagnostic | res201: drug misuse | |||
| E244z00 | Read | Amphetamine or psychostimulant dependence NOS | diagnostic | res201: drug misuse | |||
| E244z11 | Read | Amfetamine or psychostimulant dependence NOS | diagnostic | res201: drug misuse | |||
| E245.00 | Read | Hallucinogen dependence | diagnostic | res201: drug misuse | |||
| E245000 | Read | Hallucinogen dependence; unspecified | diagnostic | res201: drug misuse | |||
| E245100 | Read | Hallucinogen dependence; continuous | diagnostic | res201: drug misuse | |||
| E245.11 | Read | LSD dependence | diagnostic | res201: drug misuse | |||
| E245.12 | Read | Lysergic acid diethylamide dependence | diagnostic | res201: drug misuse | |||
| E245200 | Read | Hallucinogen dependence; episodic | diagnostic | res201: drug misuse | |||
| E245300 | Read | Hallucinogen dependence in remission | diagnostic | res201: drug misuse | |||
| E245z00 | Read | Hallucinogen dependence NOS | diagnostic | res201: drug misuse | |||
| E246.00 | Read | Glue sniffing dependence | diagnostic | res201: drug misuse | |||
| E246000 | Read | Glue sniffing dependence; unspecified | diagnostic | res201: drug misuse | |||
| E246100 | Read | Glue sniffing dependence; continuous | diagnostic | res201: drug misuse | |||
| E246200 | Read | Glue sniffing dependence; episodic | diagnostic | res201: drug misuse | |||
| E246300 | Read | Glue sniffing dependence in remission | diagnostic | res201: drug misuse | |||
| E246z00 | Read | Glue sniffing dependence NOS | diagnostic | res201: drug misuse | |||
| E247100 | Read | Other specified drug dependence; continuous | diagnostic | res201: drug misuse | |||
| E247200 | Read | Other specified drug dependence; episodic | diagnostic | res201: drug misuse | |||
| E247300 | Read | Other specified drug dependence in remission | diagnostic | res201: drug misuse | |||
| E248.00 | Read | Combined opioid with other drug dependence | diagnostic | res201: drug misuse | |||
| E248000 | Read | Combined opioid with other drug dependence; unspecified | diagnostic | res201: drug misuse | |||
| E248100 | Read | Combined opioid with other drug dependence; continuous | diagnostic | res201: drug misuse | |||
| E248200 | Read | Combined opioid with other drug dependence; episodic | diagnostic | res201: drug misuse | |||
| E248300 | Read | Combined opioid with other drug dependence in remission | diagnostic | res201: drug misuse | |||
| E248z00 | Read | Combined opioid with other drug dependence NOS | diagnostic | res201: drug misuse | |||
| E249.00 | Read | Combined drug dependence; excluding opioids | diagnostic | res201: drug misuse | |||
| E249000 | Read | Combined drug dependence; excluding opioid; unspecified | diagnostic | res201: drug misuse | |||
| E249100 | Read | Combined drug dependence; excluding opioid; continuous | diagnostic | res201: drug misuse | |||
| E249200 | Read | Combined drug dependence; excluding opioid; episodic | diagnostic | res201: drug misuse | |||
| E249300 | Read | Combined drug dependence; excluding opioid; in remission | diagnostic | res201: drug misuse | |||
| E249z00 | Read | Combined drug dependence; excluding opioid; NOS | diagnostic | res201: drug misuse | |||
| E24A.00 | Read | Ecstasy type drug dependence | diagnostic | res201: drug misuse | |||
| E24z.00 | Read | Drug dependence NOS | diagnostic | res201: drug misuse | |||
| E25..00 | Read | Nondependent abuse of drugs | diagnostic | res201: drug misuse | |||
| E252.00 | Read | Nondependent cannabis abuse | diagnostic | res201: drug misuse | |||
| E252000 | Read | Nondependent cannabis abuse; unspecified | diagnostic | res201: drug misuse | |||
| E252100 | Read | Nondependent cannabis abuse; continuous | diagnostic | res201: drug misuse | |||
| E252200 | Read | Nondependent cannabis abuse; episodic | diagnostic | res201: drug misuse | |||
| E252300 | Read | Nondependent cannabis abuse in remission | diagnostic | res201: drug misuse | |||
| E252z00 | Read | Nondependent cannabis abuse NOS | diagnostic | res201: drug misuse | |||
| E253.00 | Read | Nondependent hallucinogen abuse | diagnostic | res201: drug misuse | |||
| E253000 | Read | Nondependent hallucinogen abuse; unspecified | diagnostic | res201: drug misuse | |||
| E253100 | Read | Nondependent hallucinogen abuse; continuous | diagnostic | res201: drug misuse | |||
| E253200 | Read | Nondependent hallucinogen abuse; episodic | diagnostic | res201: drug misuse | |||
| E253300 | Read | Nondependent hallucinogen abuse in remission | diagnostic | res201: drug misuse | |||
| E253z00 | Read | Nondependent hallucinogen abuse NOS | diagnostic | res201: drug misuse | |||
| E254.00 | Read | Nondependent hypnotic or anxiolytic abuse | diagnostic | res201: drug misuse | |||
| E254000 | Read | Nondependent hypnotic or anxiolytic abuse; unspecified | diagnostic | res201: drug misuse | |||
| E254100 | Read | Nondependent hypnotic or anxiolytic abuse; continuous | diagnostic | res201: drug misuse | |||
| E254.11 | Read | Barbiturate abuse | diagnostic | res201: drug misuse | |||
| E254.12 | Read | Hypnotic or anxiolytic abuse | diagnostic | res201: drug misuse | |||
| E254.13 | Read | Sedative abuse | diagnostic | res201: drug misuse | |||
| E254.14 | Read | Tranquilliser abuse | diagnostic | res201: drug misuse | |||
| E254200 | Read | Nondependent hypnotic or anxiolytic abuse; episodic | diagnostic | res201: drug misuse | |||
| E254300 | Read | Nondependent hypnotic or anxiolytic abuse in remission | diagnostic | res201: drug misuse | |||
| E254z00 | Read | Nondependent hypnotic or anxiolytic abuse NOS | diagnostic | res201: drug misuse | |||
| E255.00 | Read | Nondependent opioid abuse | diagnostic | res201: drug misuse | |||
| E255000 | Read | Nondependent opioid abuse; unspecified | diagnostic | res201: drug misuse | |||
| E255100 | Read | Nondependent opioid abuse; continuous | diagnostic | res201: drug misuse | |||
| E255200 | Read | Nondependent opioid abuse; episodic | diagnostic | res201: drug misuse |
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