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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: schizophrenia
182 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 1BH..00 | Read | Delusions | diagnostic | res201: schizophrenia | |||
| 1BH0.00 | Read | delusion of persecution | diagnostic | res201: schizophrenia | |||
| 1BH1.00 | Read | grandiose delusions | diagnostic | res201: schizophrenia | |||
| 1BH..11 | Read | Delusion | diagnostic | res201: schizophrenia | |||
| 1BH2.00 | Read | ideas of reference | diagnostic | res201: schizophrenia | |||
| 1BH3.00 | Read | paranoid ideation | diagnostic | res201: schizophrenia | |||
| 225E.00 | Read | o/e - paranoid delusions | diagnostic | res201: schizophrenia | |||
| 225F.00 | Read | o/e - delusion of persecution | diagnostic | res201: schizophrenia | |||
| E00y.11 | Read | Presbyophrenic psychosis | diagnostic | res201: schizophrenia | |||
| E1...00 | Read | Non-organic psychoses | diagnostic | res201: schizophrenia | |||
| E10..00 | Read | Schizophrenic disorders | diagnostic | res201: schizophrenia | |||
| E100.00 | Read | Simple schizophrenia | diagnostic | res201: schizophrenia | |||
| E100000 | Read | Unspecified schizophrenia | diagnostic | res201: schizophrenia | |||
| E100100 | Read | Subchronic schizophrenia | diagnostic | res201: schizophrenia | |||
| E100.11 | Read | Schizophrenia simplex | diagnostic | res201: schizophrenia | |||
| E100200 | Read | Chronic schizophrenic | diagnostic | res201: schizophrenia | |||
| E100300 | Read | Acute exacerbation of subchronic schizophrenia | diagnostic | res201: schizophrenia | |||
| E100400 | Read | Acute exacerbation of chronic schizophrenia | diagnostic | res201: schizophrenia | |||
| E100500 | Read | Schizophrenia in remission | diagnostic | res201: schizophrenia | |||
| E100z00 | Read | simple schizophrenia nos | diagnostic | res201: schizophrenia | |||
| E101.00 | Read | Hebephrenic schizophrenia | diagnostic | res201: schizophrenia | |||
| E101000 | Read | Unspecified hebephrenic schizophrenia | diagnostic | res201: schizophrenia | |||
| E101400 | Read | Acute exacerbation of chronic hebephrenic schizophrenia | diagnostic | res201: schizophrenia | |||
| E101500 | Read | Hebephrenic schizophrenia in remission | diagnostic | res201: schizophrenia | |||
| E101z00 | Read | Hebephrenic schizophrenia NOS | diagnostic | res201: schizophrenia | |||
| E102.00 | Read | Catatonic schizophrenia | diagnostic | res201: schizophrenia | |||
| E102000 | Read | Unspecified catatonic schizophrenia | diagnostic | res201: schizophrenia | |||
| E102100 | Read | Subchronic catatonic schizophrenia | diagnostic | res201: schizophrenia | |||
| E102400 | Read | Acute exacerbation of chronic catatonic schizophrenia | diagnostic | res201: schizophrenia | |||
| E102500 | Read | Catatonic schizophrenia in remission | diagnostic | res201: schizophrenia | |||
| E102z00 | Read | Catatonic schizophrenia NOS | diagnostic | res201: schizophrenia | |||
| E103.00 | Read | Paranoid schizophrenia | diagnostic | res201: schizophrenia | |||
| E103000 | Read | Unspecified paranoid schizophrenia | diagnostic | res201: schizophrenia | |||
| E103100 | Read | Subchronic paranoid schizophrenia | diagnostic | res201: schizophrenia | |||
| E103200 | Read | Chronic paranoid schizophrenia | diagnostic | res201: schizophrenia | |||
| E103300 | Read | Acute exacerbation of subchronic paranoid schizophrenia | diagnostic | res201: schizophrenia | |||
| E103400 | Read | Acute exacerbation of chronic paranoid schizophrenia | diagnostic | res201: schizophrenia | |||
| E103z00 | Read | Paranoid schizophrenia NOS | diagnostic | res201: schizophrenia | |||
| E104.00 | Read | Acute schizophrenic episode | diagnostic | res201: schizophrenia | |||
| E105.00 | Read | latent schizophrenia | diagnostic | res201: schizophrenia | |||
| E105000 | Read | unspecified latent schizophrenia | diagnostic | res201: schizophrenia | |||
| E105200 | Read | chronic latent schizophrenia | diagnostic | res201: schizophrenia | |||
| E105z00 | Read | latent schizophrenia nos | diagnostic | res201: schizophrenia | |||
| E106.00 | Read | Residual schizophrenia | diagnostic | res201: schizophrenia | |||
| E107.00 | Read | Schizo-affective schizophrenia | diagnostic | res201: schizophrenia | |||
| E107000 | Read | Unspecified schizo-affective schizophrenia | diagnostic | res201: schizophrenia | |||
| E107100 | Read | Subchronic schizo-affective schizophrenia | diagnostic | res201: schizophrenia | |||
| E107.11 | Read | Cyclic schizophrenia | diagnostic | res201: schizophrenia | |||
| E107200 | Read | Chronic schizo-affective schizophrenia | diagnostic | res201: schizophrenia | |||
| E107300 | Read | Acute exacerbation subchronic schizo-affective schizophrenia | diagnostic | res201: schizophrenia | |||
| E107400 | Read | Acute exacerbation of chronic schizo-affective schizophrenia | diagnostic | res201: schizophrenia | |||
| E107z00 | Read | Schizo-affective schizophrenia NOS | diagnostic | res201: schizophrenia | |||
| E10y.00 | Read | Other schizophrenia | diagnostic | res201: schizophrenia | |||
| E10y000 | Read | Atypical schizophrenia | diagnostic | res201: schizophrenia | |||
| E10y100 | Read | Coenesthopathic schizophrenia | diagnostic | res201: schizophrenia | |||
| E10y.11 | Read | Cenesthopathic schizophrenia | diagnostic | res201: schizophrenia | |||
| E10yz00 | Read | Other schizophrenia NOS | diagnostic | res201: schizophrenia | |||
| E10z.00 | Read | Schizophrenia NOS | diagnostic | res201: schizophrenia | |||
| E11..00 | Read | Affective psychoses | diagnostic | res201: schizophrenia | |||
| E11z.00 | Read | Other and unspecified affective psychoses | diagnostic | res201: schizophrenia | |||
| E11z000 | Read | Unspecified affective psychoses NOS | diagnostic | res201: schizophrenia | |||
| E11zz00 | Read | Other affective psychosis NOS | diagnostic | res201: schizophrenia | |||
| E12..00 | Read | paranoid states | diagnostic | res201: schizophrenia | |||
| E120.00 | Read | simple paranoid state | diagnostic | res201: schizophrenia | |||
| E121.00 | Read | Chronic paranoid psychosis | diagnostic | res201: schizophrenia | |||
| E122.00 | Read | Paraphrenia | diagnostic | res201: schizophrenia | |||
| E123.00 | Read | shared paranoid disorder | diagnostic | res201: schizophrenia | |||
| E123.11 | Read | folie a deux | diagnostic | res201: schizophrenia | |||
| E12y.00 | Read | other paranoid states | diagnostic | res201: schizophrenia | |||
| E12y000 | Read | paranoia querulans | diagnostic | res201: schizophrenia | |||
| E12yz00 | Read | other paranoid states nos | diagnostic | res201: schizophrenia | |||
| E12z.00 | Read | Paranoid psychosis NOS | diagnostic | res201: schizophrenia | |||
| E13..00 | Read | Other nonorganic psychoses | diagnostic | res201: schizophrenia | |||
| E130.00 | Read | reactive depressive psychosis | diagnostic | res201: schizophrenia | |||
| E130.11 | Read | psychotic reactive depression | diagnostic | res201: schizophrenia | |||
| E131.00 | Read | acute hysterical psychosis | diagnostic | res201: schizophrenia | |||
| E13..11 | Read | reactive psychoses | diagnostic | res201: schizophrenia | |||
| E133.00 | Read | acute paranoid reaction | diagnostic | res201: schizophrenia | |||
| E134.00 | Read | Psychogenic paranoid psychosis | diagnostic | res201: schizophrenia | |||
| E13y.00 | Read | other reactive psychoses | diagnostic | res201: schizophrenia | |||
| E13y100 | Read | brief reactive psychosis | diagnostic | res201: schizophrenia | |||
| E13yz00 | Read | other reactive psychoses nos | diagnostic | res201: schizophrenia | |||
| E13z.00 | Read | nonorganic psychosis nos | diagnostic | res201: schizophrenia | |||
| E13z.11 | Read | psychotic episode nos | diagnostic | res201: schizophrenia | |||
| E14..00 | Read | Psychoses with origin in childhood | diagnostic | res201: schizophrenia | |||
| E141.00 | Read | Disintegrative psychosis | diagnostic | res201: schizophrenia | |||
| E141100 | Read | Residual disintegrative psychoses | diagnostic | res201: schizophrenia | |||
| E141.11 | Read | heller's syndrome | diagnostic | res201: schizophrenia | |||
| E1y..00 | Read | Other specified non-organic psychoses | diagnostic | res201: schizophrenia | |||
| E1z..00 | Read | Non-organic psychosis NOS | diagnostic | res201: schizophrenia | |||
| E201900 | Read | Multiple personality | diagnostic | res201: schizophrenia | |||
| Eu02z12 | Read | [X] Presenile psychosis NOS | diagnostic | res201: schizophrenia | |||
| Eu0z.12 | Read | [X]Symptomatic psychosis NOS | diagnostic | res201: schizophrenia | |||
| Eu2..00 | Read | [X]Schizophrenia, schizotypal and delusional disorders | diagnostic | res201: schizophrenia | |||
| Eu20.00 | Read | [X]Schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20000 | Read | [X]Paranoid schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20011 | Read | [X]Paraphrenic schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20100 | Read | [X]Hebephrenic schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20111 | Read | [X]Disorganised schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20200 | Read | [X]Catatonic schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20211 | Read | [x]catatonic stupor | diagnostic | res201: schizophrenia | |||
| Eu20212 | Read | [X]Schizophrenic catalepsy | diagnostic | res201: schizophrenia | |||
| Eu20213 | Read | [X]Schizophrenic catatonia | diagnostic | res201: schizophrenia | |||
| Eu20214 | Read | [X]Schizophrenic flexibilatis cerea | diagnostic | res201: schizophrenia | |||
| Eu20300 | Read | [X]Undifferentiated schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20311 | Read | [X]Atypical schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20500 | Read | [X]Residual schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20511 | Read | [X]Chronic undifferentiated schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20600 | Read | [x]simple schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20y00 | Read | [X]Other schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu20y12 | Read | [X]Schizophreniform disord NOS | diagnostic | res201: schizophrenia | |||
| Eu20y13 | Read | [X]Schizophrenifrm psychos NOS | diagnostic | res201: schizophrenia | |||
| Eu20z00 | Read | [X]Schizophrenia, unspecified | diagnostic | res201: schizophrenia | |||
| Eu21.00 | Read | [X]Schizotypal disorder | diagnostic | res201: schizophrenia | |||
| Eu21.11 | Read | [x]latent schizophrenic reaction | diagnostic | res201: schizophrenia | |||
| Eu21.12 | Read | [x]borderline schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu21.13 | Read | [x]latent schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu21.14 | Read | [x]prepsychotic schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu21.15 | Read | [x]prodromal schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu21.16 | Read | [X]Pseudoneurotic schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu21.17 | Read | [X]Pseudopsychopathic schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu22.00 | Read | [X]Persistent delusional disorders | diagnostic | res201: schizophrenia | |||
| Eu22000 | Read | [X]Delusional disorder | diagnostic | res201: schizophrenia | |||
| Eu22011 | Read | [X]Paranoid psychosis | diagnostic | res201: schizophrenia | |||
| Eu22012 | Read | [x]paranoid state | diagnostic | res201: schizophrenia | |||
| Eu22013 | Read | [X]Paraphrenia - late | diagnostic | res201: schizophrenia | |||
| Eu22014 | Read | [x]sensitiver beziehungswahn | diagnostic | res201: schizophrenia | |||
| Eu22015 | Read | [x]paranoia | diagnostic | res201: schizophrenia | |||
| Eu22100 | Read | [X]Delusional misidentification syndrome | diagnostic | res201: schizophrenia | |||
| Eu22111 | Read | [X]Capgras syndrome | diagnostic | res201: schizophrenia | |||
| Eu22y00 | Read | [X]Other persistent delusional disorders | diagnostic | res201: schizophrenia | |||
| Eu22y11 | Read | [x]delusional dysmorphophobia | diagnostic | res201: schizophrenia | |||
| Eu22y12 | Read | [x]involutional paranoid state | diagnostic | res201: schizophrenia | |||
| Eu22y13 | Read | [x]paranoia querulans | diagnostic | res201: schizophrenia | |||
| Eu22z00 | Read | [X]Persistent delusional disorder, unspecified | diagnostic | res201: schizophrenia | |||
| Eu23.00 | Read | [x]acute and transient psychotic disorders | diagnostic | res201: schizophrenia | |||
| Eu23000 | Read | [x]acute polymorphic psychot disord without symp of schizoph | diagnostic | res201: schizophrenia | |||
| Eu23011 | Read | [x]bouffee delirante | diagnostic | res201: schizophrenia | |||
| Eu23012 | Read | [X]Cycloid psychosis | diagnostic | res201: schizophrenia | |||
| Eu23100 | Read | [x]acute polymorphic psychot disord with symp of schizophren | diagnostic | res201: schizophrenia | |||
| Eu23112 | Read | [X]Cycloid psychosis with symptoms of schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu23200 | Read | [x]acute schizophrenia-like psychotic disorder | diagnostic | res201: schizophrenia | |||
| Eu23211 | Read | [x]brief schizophreniform disorder | diagnostic | res201: schizophrenia | |||
| Eu23212 | Read | [x]brief schizophrenifrm psych | diagnostic | res201: schizophrenia | |||
| Eu23214 | Read | [X]Schizophrenic reaction | diagnostic | res201: schizophrenia | |||
| Eu23300 | Read | [x]other acute predominantly delusional psychotic disorders | diagnostic | res201: schizophrenia | |||
| Eu23312 | Read | [X]Psychogenic paranoid psychosis | diagnostic | res201: schizophrenia | |||
| Eu23y00 | Read | [x]other acute and transient psychotic disorders | diagnostic | res201: schizophrenia | |||
| Eu23z00 | Read | [x]acute and transient psychotic disorder, unspecified | diagnostic | res201: schizophrenia | |||
| Eu23z11 | Read | [x]brief reactive psychosis nos | diagnostic | res201: schizophrenia | |||
| Eu23z12 | Read | [x]reactive psychosis | diagnostic | res201: schizophrenia | |||
| Eu25.00 | Read | [X]Schizoaffective disorders | diagnostic | res201: schizophrenia | |||
| Eu25000 | Read | [X]Schizoaffective disorder, manic type | diagnostic | res201: schizophrenia | |||
| Eu25011 | Read | [X]Schizoaffective psychosis, manic type | diagnostic | res201: schizophrenia | |||
| Eu25012 | Read | [X]Schizophreniform psychosis, manic type | diagnostic | res201: schizophrenia | |||
| Eu25100 | Read | [X]Schizoaffective disorder, depressive type | diagnostic | res201: schizophrenia | |||
| Eu25111 | Read | [X]Schizoaffective psychosis, depressive type | diagnostic | res201: schizophrenia | |||
| Eu25112 | Read | [X]Schizophreniform psychosis, depressive type | diagnostic | res201: schizophrenia | |||
| Eu25200 | Read | [X]Schizoaffective disorder, mixed type | diagnostic | res201: schizophrenia | |||
| Eu25211 | Read | [X]Cyclic schizophrenia | diagnostic | res201: schizophrenia | |||
| Eu25212 | Read | [X]Mixed schizophrenic and affective psychosis | diagnostic | res201: schizophrenia | |||
| Eu25y00 | Read | [X]Other schizoaffective disorders | diagnostic | res201: schizophrenia | |||
| Eu25z00 | Read | [X]Schizoaffective disorder, unspecified | diagnostic | res201: schizophrenia | |||
| Eu25z11 | Read | [X]Schizoaffective psychosis NOS | diagnostic | res201: schizophrenia | |||
| Eu2y.00 | Read | [X]Other nonorganic psychotic disorders | diagnostic | res201: schizophrenia | |||
| Eu2y.11 | Read | [X]Chronic hallucinatory psychosis | diagnostic | res201: schizophrenia | |||
| Eu2z.00 | Read | [x]unspecified nonorganic psychosis | diagnostic | res201: schizophrenia | |||
| Eu2z.11 | Read | [X]Psychosis NOS | diagnostic | res201: schizophrenia | |||
| Eu3z.11 | Read | [X]Affective psychosis NOS | diagnostic | res201: schizophrenia | |||
| Eu44.14 | Read | [X]Hysterical psychosis | diagnostic | res201: schizophrenia | |||
| Eu44y12 | Read | [X]Multiple personality | diagnostic | res201: schizophrenia | |||
| Eu84312 | Read | [X]Disintegrative psychosis | diagnostic | res201: schizophrenia | |||
| Eu84314 | Read | [x]symbiotic psychosis | diagnostic | res201: schizophrenia | |||
| R001.00 | Read | [d]hallucinations | diagnostic | res201: schizophrenia | |||
| R001000 | Read | [d]hallucinations, auditory | diagnostic | res201: schizophrenia | |||
| R001100 | Read | [d]hallucinations, gustatory | diagnostic | res201: schizophrenia | |||
| R001200 | Read | [d]hallucinations, olfactory | diagnostic | res201: schizophrenia | |||
| R001300 | Read | [d]hallucinations, tactile | diagnostic | res201: schizophrenia | |||
| R001400 | Read | [d]visual hallucinations | diagnostic | res201: schizophrenia | |||
| R001z00 | Read | [d]hallucinations nos | diagnostic | res201: schizophrenia | |||
| Ryu5300 | Read | [x]other hallucinations | diagnostic | res201: schizophrenia | |||
| ZS7C611 | Read | schizophrenic language | diagnostic | res201: schizophrenia |
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