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Research article:
Clinical management following self-harm in a UK-wide primary care cohort
Reference:
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:
- Link to article
- Abstract
- 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.
- Author for correspondence
- Matthew J Carr
- Email for correspondence
- matthew.carr@manchester.ac.uk
Code list: res36: Anxiolitics
40 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 39801020 | Multilex | Zimovane 7.5mg tablets (Lexon (UK) Ltd) | drug | res36: Anxiolitics | |||
| 479021 | Multilex | Zopiclone 3.75mg/5ml oral solution | drug | res36: Anxiolitics | |||
| 59209020 | Multilex | Zopiclone 7.5mg tablets (Actavis UK Ltd) | drug | res36: Anxiolitics | |||
| 59210020 | Multilex | Zopiclone 3.75mg tablets (Actavis UK Ltd) | drug | res36: Anxiolitics | |||
| 59236020 | Multilex | Zopiclone 3.75mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res36: Anxiolitics | |||
| 59237020 | Multilex | Zopiclone 7.5mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res36: Anxiolitics | |||
| 59593020 | Multilex | Zopiclone 3.75mg tablets (Teva UK Ltd) | drug | res36: Anxiolitics | |||
| 59594020 | Multilex | Zopiclone 7.5mg tablets (Teva UK Ltd) | drug | res36: Anxiolitics | |||
| 59784020 | Multilex | Zopiclone 7.5mg tablets (Generics (UK) Ltd) | drug | res36: Anxiolitics | |||
| 59785020 | Multilex | Zopiclone 3.75mg tablets (Generics (UK) Ltd) | drug | res36: Anxiolitics | |||
| 60509020 | Multilex | Zopiclone 3.75mg tablets (A A H Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 60510020 | Multilex | Zopiclone 7.5mg tablets (A A H Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 62715020 | Multilex | Zopiclone 7.5mg tablets (Sandoz Ltd) | drug | res36: Anxiolitics | |||
| 63436020 | Multilex | Zopiclone 7.5mg tablets (Kent Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 63765020 | Multilex | Zopiclone 7.5mg tablets (PLIVA Pharma Ltd) | drug | res36: Anxiolitics | |||
| 63881020 | Multilex | Zolpidem 5mg Tablet (Winthrop Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 63882020 | Multilex | Zolpidem 10mg Tablet (Winthrop Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 64484020 | Multilex | Zolpidem 5mg tablets (Teva UK Ltd) | drug | res36: Anxiolitics | |||
| 64487020 | Multilex | Zolpidem 10mg tablets (Teva UK Ltd) | drug | res36: Anxiolitics | |||
| 64733020 | Multilex | Zolpidem 5mg tablets (A A H Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 64738020 | Multilex | Zolpidem 10mg tablets (A A H Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 65546020 | Multilex | Zopiclone 3.75mg tablets (Kent Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 65832020 | Multilex | Zolpidem 5mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res36: Anxiolitics | |||
| 65835020 | Multilex | Zolpidem 10mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res36: Anxiolitics | |||
| 66946020 | Multilex | Zolpidem 10mg tablets (Generics (UK) Ltd) | drug | res36: Anxiolitics | |||
| 72408020 | Multilex | Zimovane 7.5mg tablets (Sanofi) | drug | res36: Anxiolitics | |||
| 72416020 | Multilex | Zopiclone 7.5mg tablets | drug | res36: Anxiolitics | |||
| 72417020 | Multilex | Zopiclone 3.75mg tablets | drug | res36: Anxiolitics | |||
| 75692020 | Multilex | Zolpidem 5mg tablets | drug | res36: Anxiolitics | |||
| 75693020 | Multilex | Zolpidem 10mg tablets | drug | res36: Anxiolitics | |||
| 75696020 | Multilex | Stilnoct 5mg tablets (Sanofi) | drug | res36: Anxiolitics | |||
| 75697020 | Multilex | Stilnoct 10mg tablets (Sanofi) | drug | res36: Anxiolitics | |||
| 83069020 | Multilex | Zimovane LS 3.75mg tablets (Sanofi) | drug | res36: Anxiolitics | |||
| 85821020 | Multilex | Zileze 3.75 tablets (Opus Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 85822020 | Multilex | Zileze 7.5 tablets (Opus Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 86240020 | Multilex | Zaleplon 5mg capsules | drug | res36: Anxiolitics | |||
| 86241020 | Multilex | Zaleplon 10mg capsules | drug | res36: Anxiolitics | |||
| 86243020 | Multilex | Sonata 5mg capsules (Meda Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 86244020 | Multilex | Sonata 10mg capsules (Meda Pharmaceuticals Ltd) | drug | res36: Anxiolitics | |||
| 91009020 | Multilex | Zopiclone 3.75mg/5ml oral suspension | drug | res36: Anxiolitics |
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