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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: Self-harm ICD10

50 codes in list

Code Coding system Description Entity type List name
X60 ICD-10 Intentional self-poisoning by andexposure to nonopioid, analgesics, antipyretics and antirheumatics diagnostic res201: Self-harm ICD10
X61 ICD-10 Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and diagnostic res201: Self-harm ICD10
X62 ICD-10 Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not el diagnostic res201: Self-harm ICD10
X63 ICD-10 Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system diagnostic res201: Self-harm ICD10
X64 ICD-10 Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biologica diagnostic res201: Self-harm ICD10
X65 ICD-10 Intentional self-poisoning by and exposure to alcohol diagnostic res201: Self-harm ICD10
X66 ICD-10 Intentional self-poisoning by and exposure to organic solvents and halogenated hydrocarbons and thei diagnostic res201: Self-harm ICD10
X67 ICD-10 Intentional self-poisoning by and exposure to other gases and vapours diagnostic res201: Self-harm ICD10
X68 ICD-10 Intentional self-poisoning by and exposure to pesticides diagnostic res201: Self-harm ICD10
X69 ICD-10 Intentional self-poisoning by and exposure to other and unspecified chemicals and noxious substances diagnostic res201: Self-harm ICD10
X70 ICD-10 Intentional self-harm by hanging, strangulation and suffocation diagnostic res201: Self-harm ICD10
X71 ICD-10 Intentional self-harm by drowning and submersion diagnostic res201: Self-harm ICD10
X72 ICD-10 Intentional self-harm by handgun discharge diagnostic res201: Self-harm ICD10
X73 ICD-10 Intentional self-harm by rifle, shotgun and larger firearm discharge diagnostic res201: Self-harm ICD10
X74 ICD-10 Intentional self-harm by other and unspecified firearm discharge diagnostic res201: Self-harm ICD10
X75 ICD-10 Intentional self-harm by explosive material diagnostic res201: Self-harm ICD10
X76 ICD-10 Intentional self-harm by smoke, fire and flames diagnostic res201: Self-harm ICD10
X77 ICD-10 Intentional self-harm by steam, hot vapours and hot objects diagnostic res201: Self-harm ICD10
X78 ICD-10 Intentional self-harm by sharp object diagnostic res201: Self-harm ICD10
X79 ICD-10 Intentional self-harm by blunt object diagnostic res201: Self-harm ICD10
X80 ICD-10 Intentional self-harm by jumping from a high place diagnostic res201: Self-harm ICD10
X81 ICD-10 Intentional self-harm by jumping or lying before moving object diagnostic res201: Self-harm ICD10
X82 ICD-10 Intentional self-harm by crashing of motor vehicle diagnostic res201: Self-harm ICD10
X83 ICD-10 Intentional self-harm by other specified means diagnostic res201: Self-harm ICD10
X84 ICD-10 Intentional self-harm by unspecified means diagnostic res201: Self-harm ICD10
Y10 ICD-10 Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics, undetermined int diagnostic res201: Self-harm ICD10
Y11 ICD-10 Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic dru diagnostic res201: Self-harm ICD10
Y12 ICD-10 Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classifie diagnostic res201: Self-harm ICD10
Y13 ICD-10 Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent diagnostic res201: Self-harm ICD10
Y14 ICD-10 Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, und diagnostic res201: Self-harm ICD10
Y15 ICD-10 Poisoning by and exposure to alcohol, undetermined intent diagnostic res201: Self-harm ICD10
Y16 ICD-10 Poisoning by and exposure to organic solvents and halogenated hydrocarbons and their vapours, undete diagnostic res201: Self-harm ICD10
Y17 ICD-10 Poisoning by and exposure to other gases and vapours, undetermined intent diagnostic res201: Self-harm ICD10
Y18 ICD-10 Poisoning by and exposure to pesticides, undetermined intent diagnostic res201: Self-harm ICD10
Y19 ICD-10 Poisoning by and exposure to other and unspecified chemicals and noxious substances, undetermined in diagnostic res201: Self-harm ICD10
Y20 ICD-10 Hanging, strangulation and suffocation, undetermined intent diagnostic res201: Self-harm ICD10
Y21 ICD-10 Drowning and submersion, undetermined intent diagnostic res201: Self-harm ICD10
Y22 ICD-10 Handgun discharge, undetermined intent diagnostic res201: Self-harm ICD10
Y23 ICD-10 Rifle, shotgun and larger firearm discharge, undetermined intent diagnostic res201: Self-harm ICD10
Y24 ICD-10 Other and unspecified firearm discharge, undetermined intent diagnostic res201: Self-harm ICD10
Y25 ICD-10 Contact with explosive material, undetermined intent diagnostic res201: Self-harm ICD10
Y26 ICD-10 Exposure to smoke, fire and flames, undetermined intent diagnostic res201: Self-harm ICD10
Y27 ICD-10 Contact with steam, hot vapours and hot objects, undetermined intent diagnostic res201: Self-harm ICD10
Y28 ICD-10 Contact with sharp object, undetermined intent diagnostic res201: Self-harm ICD10
Y29 ICD-10 Contact with blunt object, undetermined intent diagnostic res201: Self-harm ICD10
Y30 ICD-10 Falling, jumping or pushed from a high place, undetermined intent diagnostic res201: Self-harm ICD10
Y31 ICD-10 Falling, lying or running before or into moving object, undetermined intent diagnostic res201: Self-harm ICD10
Y32 ICD-10 Crashing of motor vehicle, undetermined intent diagnostic res201: Self-harm ICD10
Y33 ICD-10 Other specified events, undetermined intent diagnostic res201: Self-harm ICD10
Y34 ICD-10 Unspecified event, undetermined intent diagnostic res201: Self-harm ICD10

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