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Research article:

Clinical management following self-harm in a UK-wide primary care cohort


Matthew J Carr, Darren M Ashcroft, Evan Kontopantelis, David While, Yvonne Awenat, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb(2016) Clinical management following self-harm in a UK-wide primary care cohort. Journal of Affective Disorders, doi:

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Background: Little is known about the clinical management of patients in primary care following self-harm. Methods: A descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPRD) during 2001-2013. We identified 49,970 patients with a self-harm episode, 41,500 of whom had one complete year of follow-up. Results: Among those with complete follow-up, 26,065 (62.8%, 62.3-63.3) were prescribed psychotropic medication and 6,318 (15.2%, 14.9-15.6) were referred to mental health services; 4,105 (9.9%, CI 9.6-10.2) were medicated without an antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6-11.2) had a diagnosis but were not subsequently medicated or referred. Patients registered at practices in the most deprived localities were 27.1% (CI 21.5-32.2) less likely to be referred than those in the least deprived. Despite a specifically flagged NICE ‘Do not do’ recommendation in 2011 against prescribing tricyclic antidepressants following self-harm because of their potentially lethal toxicity in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert issued in 2011. Conclusions: A relatively small percentage of these vulnerable patients are referred to mental health services, and reduced likelihood of referral in more deprived localities reflects a marked health inequality. National clinical guidelines have not yet been effective in reducing rates of tricyclic antidepressant prescribing for this high-risk group.
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Matthew J Carr
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Res36: Self-harm Download this codelist
Res36: Anxiety Download this codelist
Res36: Bipolar disorder Download this codelist
Res36: Depression Download this codelist
Res36: Eating disorder Download this codelist
Res36: Personality disorder Download this codelist
Res36: Schizophrenia spectrum Download this codelist
Res36: Anxiolitics Download this codelist
Res36: Atypical APDs Download this codelist
Res36: Benzodiazepines Download this codelist
Res36: Depot APDs Download this codelist
Res36: Lithium and other mood stabilisers Download this codelist
Res36: Opioid analgesics Download this codelist
Res36: Other ADDs Download this codelist
Res36: SSRI ADDs Download this codelist
Res36: Tricyclic ADDs Download this codelist
Res36: Typical APDs Download this codelist

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