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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: sleep problems

55 codes in list

Code Coding system Description Entity type List name
1B1B.00 Read Cannot sleep - insomnia diagnostic res201: sleep problems
1B1B000 Read Initial insomnia diagnostic res201: sleep problems
1B1B100 Read Middle insomnia diagnostic res201: sleep problems
1B1B.11 Read C/O - insomnia diagnostic res201: sleep problems
1B1B200 Read Late insomnia diagnostic res201: sleep problems
1B1Q.00 Read Poor sleep pattern diagnostic res201: sleep problems
1BX0.00 Read Delayed onset of sleep diagnostic res201: sleep problems
1BX9.00 Read Light sleep diagnostic res201: sleep problems
8HTn.00 Read Referral to sleep clinic diagnostic res201: sleep problems
8Q0..00 Read Sleep management diagnostic res201: sleep problems
9Nk0.00 Read Seen in sleep clinic diagnostic res201: sleep problems
E274.00 Read Non-organic sleep disorders diagnostic res201: sleep problems
E274000 Read Unspecified non-organic sleep disorder diagnostic res201: sleep problems
E274100 Read Transient insomnia diagnostic res201: sleep problems
E274111 Read Insomnia NOS diagnostic res201: sleep problems
E274.12 Read Insomnia due to nonorganic sleep disorder diagnostic res201: sleep problems
E274200 Read Persistent insomnia diagnostic res201: sleep problems
E274B00 Read Repeated rapid eye movement sleep interruptions diagnostic res201: sleep problems
E274D11 Read Restless sleep diagnostic res201: sleep problems
E274E00 Read 'Short-sleeper' diagnostic res201: sleep problems
E274F00 Read Inversion of sleep rhythm diagnostic res201: sleep problems
E274y00 Read Other non-organic sleep disorder diagnostic res201: sleep problems
E274z00 Read Non-organic sleep disorder NOS diagnostic res201: sleep problems
Eu51.00 Read [X]Nonorganic sleep disorders diagnostic res201: sleep problems
Eu51000 Read [X]Nonorganic insomnia diagnostic res201: sleep problems
Eu51200 Read [X]Nonorganic disorder of the sleep-wake schedule diagnostic res201: sleep problems
Eu51213 Read [X]Psychogenic inversion of sleep rhythm diagnostic res201: sleep problems
Eu51300 Read [X]Sleepwalking diagnostic res201: sleep problems
Eu51400 Read [X]Sleep terrors diagnostic res201: sleep problems
Eu51y00 Read [X]Other nonorganic sleep disorders diagnostic res201: sleep problems
Eu51z00 Read [X]Nonorganic sleep disorder, unspecified diagnostic res201: sleep problems
Eu51z11 Read [X]Emotional sleep disorder NOS diagnostic res201: sleep problems
Fy0..00 Read Sleep disorders diagnostic res201: sleep problems
Fy00.00 Read Disorders of initiating and maintaining sleep diagnostic res201: sleep problems
Fy02.00 Read Disorders of the sleep-wake schedule diagnostic res201: sleep problems
Fy03.00 Read Sleep apnoea diagnostic res201: sleep problems
Fy03.11 Read Obstructive sleep apnoea diagnostic res201: sleep problems
Fyu5800 Read [X]Other sleep disorders diagnostic res201: sleep problems
H5B..00 Read Sleep apnoea diagnostic res201: sleep problems
H5B0.00 Read Obstructive sleep apnoea diagnostic res201: sleep problems
R005.00 Read [D]Sleep disturbances diagnostic res201: sleep problems
R005000 Read [D]Sleep disturbance, unspecified diagnostic res201: sleep problems
R005100 Read [D]Insomnia with sleep apnoea diagnostic res201: sleep problems
R005.11 Read [D]Insomnia - symptom diagnostic res201: sleep problems
R005.12 Read [D]Sleep rhythm problems diagnostic res201: sleep problems
R005200 Read [D]Insomnia NOS diagnostic res201: sleep problems
R005300 Read [D]Hypersomnia with sleep apnoea diagnostic res201: sleep problems
R005311 Read [D]Sleep apnoea syndrome diagnostic res201: sleep problems
R005312 Read [D]Syndrome sleep apnoea diagnostic res201: sleep problems
R005600 Read [D]Sleep rhythm irregular diagnostic res201: sleep problems
R005800 Read [D]Sleep dysfunction with sleep stage disturbance diagnostic res201: sleep problems
R005900 Read [D]Sleep dysfunction with arousal disturbance diagnostic res201: sleep problems
R005z00 Read [D]Sleep dysfunction NOS diagnostic res201: sleep problems
Z1M1.00 Read Disturbing sleep diagnostic res201: sleep problems
ZV1B100 Read [V]Personal history of unhealthy sleep-wake schedule diagnostic res201: sleep problems

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