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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: Other ADDs

128 codes in list

Code Coding system Description Entity type List name
03818020 Multilex Fluanxol 1mg tablets (Sigma Pharmaceuticals Plc) drug res36: Other ADDs
03942020 Multilex Venlafaxine 37.5mg tablets (Ranbaxy (UK) Ltd) drug res36: Other ADDs
03965020 Multilex Venlablue XL 75mg capsules (Bluefish Pharmaceuticals AB) drug res36: Other ADDs
03966020 Multilex Alventa XL 75mg capsules (Consilient Health Ltd) drug res36: Other ADDs
03970020 Multilex Efexor XL 150mg capsules (Waymade Healthcare Plc) drug res36: Other ADDs
03976020 Multilex Venlablue XL 150mg capsules (Bluefish Pharmaceuticals AB) drug res36: Other ADDs
03977020 Multilex Alventa XL 150mg capsules (Consilient Health Ltd) drug res36: Other ADDs
09892020 Multilex Zispin SolTab 15mg orodispersible tablets (Necessity Supplies Ltd) drug res36: Other ADDs
09905020 Multilex Zispin SolTab 30mg orodispersible tablets (Necessity Supplies Ltd) drug res36: Other ADDs
10967020 Multilex Duloxetine 60mg gastro-resistant capsules (Sigma Pharmaceuticals Plc) drug res36: Other ADDs
21206020 Multilex Mirtazapine 15mg/ml oral solution sugar free (A A H Pharmaceuticals Ltd) drug res36: Other ADDs
35355020 Multilex Venlafaxine 150mg/5ml oral solution drug res36: Other ADDs
35357020 Multilex Venlafaxine 37.5mg/5ml oral solution drug res36: Other ADDs
35359020 Multilex Venlafaxine 75mg/5ml oral solution drug res36: Other ADDs
38595020 Multilex Mirtazapine 15mg tablets (Medreich Plc) drug res36: Other ADDs
41252020 Multilex Mirtazapine 15mg orodispersible tablets sugar free drug res36: Other ADDs
41253020 Multilex Mirtazapine 15mg orodispersible tablets sugar free (Sandoz Ltd) drug res36: Other ADDs
41254020 Multilex Mirtazapine 45mg orodispersible tablets sugar free drug res36: Other ADDs
48376020 Multilex Efexor 37.5mg tablets (Wyeth Pharmaceuticals) drug res36: Other ADDs
48377020 Multilex Efexor 75mg tablets (Wyeth Pharmaceuticals) drug res36: Other ADDs
49502020 Multilex Fluanxol 500microgram tablets (Lundbeck Ltd) drug res36: Other ADDs
49503020 Multilex Fluanxol 1mg tablets (Lundbeck Ltd) drug res36: Other ADDs
50286020 Multilex Marplan 10mg Tablet (Cambridge Laboratories Ltd) drug res36: Other ADDs
50620020 Multilex Nardil 15mg tablets (Archimedes Pharma UK Ltd) drug res36: Other ADDs
50868020 Multilex Optimax 500mg tablets (Merck Serono Ltd) drug res36: Other ADDs
50957020 Multilex Pacitron 500mg Tablet (Rorer Pharmaceuticals Ltd) drug res36: Other ADDs
51010020 Multilex Parnate 10mg Tablet (Goldshield Pharmaceuticals Ltd) drug res36: Other ADDs
51013020 Multilex Parstelin Tablet (GlaxoSmithKline Consumer Healthcare) drug res36: Other ADDs
54686020 Multilex Venlafaxine 37.5mg tablets drug res36: Other ADDs
54687020 Multilex Venlafaxine 75mg tablets drug res36: Other ADDs
54978020 Multilex Optimax wv Tablet (E. Merck) drug res36: Other ADDs
59180020 Multilex Isocarboxazid 10mg Tablet (Cambridge Laboratories Ltd) drug res36: Other ADDs
62025020 Multilex Flupentixol 500microgram tablets drug res36: Other ADDs
62026020 Multilex Flupentixol 1mg tablets drug res36: Other ADDs
63638020 Multilex Isocarboxazid 10mg tablets drug res36: Other ADDs
63795020 Multilex Moclobemide 150mg tablets (Teva UK Ltd) drug res36: Other ADDs
65266020 Multilex Tranylcypromine 10mg tablets (AMCo) drug res36: Other ADDs
65635020 Multilex Phenelzine 15mg tablets drug res36: Other ADDs
67145020 Multilex Tranylcypromine 10mg tablets drug res36: Other ADDs
67148020 Multilex Tranylcypromine with trifluoperazine Tablet drug res36: Other ADDs
67310020 Multilex Tryptophan 500mg tablets drug res36: Other ADDs
67314020 Multilex Tryptophan with ascorbic acid and pyridoxine powder drug res36: Other ADDs
68128020 Multilex Mirtazapine 15mg/ml oral solution sugar free (Rosemont Pharmaceuticals Ltd) drug res36: Other ADDs
68213020 Multilex Mirtazapine 30mg tablets (Actavis UK Ltd) drug res36: Other ADDs
68484020 Multilex Mirtazapine 30mg tablets (A A H Pharmaceuticals Ltd) drug res36: Other ADDs
69003020 Multilex Trifluoperazine with tranylcypromine 1mg + 10mg Tablet drug res36: Other ADDs
69827020 Multilex Mirtazapine 15mg tablets (A A H Pharmaceuticals Ltd) drug res36: Other ADDs
69832020 Multilex Mirtazapine 45mg tablets (A A H Pharmaceuticals Ltd) drug res36: Other ADDs
70353020 Multilex Mirtazapine 15mg tablets (Arrow Generics Ltd) drug res36: Other ADDs
71074020 Multilex Mirtazapine 15mg tablets (Genus Pharmaceuticals Ltd) drug res36: Other ADDs
71994020 Multilex Manerix 150mg tablets (Meda Pharmaceuticals Ltd) drug res36: Other ADDs
71995020 Multilex Manerix 300mg tablets (Meda Pharmaceuticals Ltd) drug res36: Other ADDs
72031020 Multilex Moclobemide 150mg tablets drug res36: Other ADDs
72032020 Multilex Moclobemide 300mg tablets drug res36: Other ADDs
74026020 Multilex Mirtazapine 15mg orodispersible tablets (Teva UK Ltd) drug res36: Other ADDs
74033020 Multilex Mirtazapine 45mg orodispersible tablets (Teva UK Ltd) drug res36: Other ADDs
74665020 Multilex Mirtazapine 30mg orodispersible tablets (Actavis UK Ltd) drug res36: Other ADDs
74668020 Multilex Mirtazapine 45mg orodispersible tablets (Actavis UK Ltd) drug res36: Other ADDs
74684020 Multilex Mirtazapine 15mg orodispersible tablets (Focus Pharmaceuticals Ltd) drug res36: Other ADDs
74689020 Multilex Mirtazapine 45mg orodispersible tablets (Focus Pharmaceuticals Ltd) drug res36: Other ADDs
74702020 Multilex Mirtazapine 15mg orodispersible tablets (A A H Pharmaceuticals Ltd) drug res36: Other ADDs
74705020 Multilex Mirtazapine 30mg orodispersible tablets (A A H Pharmaceuticals Ltd) drug res36: Other ADDs
74708020 Multilex Mirtazapine 45mg orodispersible tablets (A A H Pharmaceuticals Ltd) drug res36: Other ADDs
74967020 Multilex Mirtazapine 15mg orodispersible tablets (Genus Pharmaceuticals Ltd) drug res36: Other ADDs
74977020 Multilex Mirtazapine 45mg orodispersible tablets (Genus Pharmaceuticals Ltd) drug res36: Other ADDs
75309020 Multilex Mirtazapine 15mg tablets (Teva UK Ltd) drug res36: Other ADDs
76425020 Multilex Mirtazapine 15mg tablets (Actavis UK Ltd) drug res36: Other ADDs
76512020 Multilex Mirtazapine 15mg orodispersible tablets (Aurobindo Pharma Ltd) drug res36: Other ADDs
78577020 Multilex Mirtazapine 30mg orodispersible tablets (Almus Pharmaceuticals Ltd) drug res36: Other ADDs
84955020 Multilex Reboxetine 4mg tablets drug res36: Other ADDs
84961020 Multilex Edronax 4mg tablets (Pfizer Ltd) drug res36: Other ADDs
85108020 Multilex Venlafaxine 75mg modified-release capsules drug res36: Other ADDs
85109020 Multilex Venlafaxine 150mg modified-release capsules drug res36: Other ADDs
85163020 Multilex Efexor XL 75mg capsules (Pfizer Ltd) drug res36: Other ADDs
85164020 Multilex Efexor XL 150mg capsules (Pfizer Ltd) drug res36: Other ADDs
85247020 Multilex Mirtazapine 30mg tablets drug res36: Other ADDs
85251020 Multilex Zispin 30mg tablets (Organon Laboratories Ltd) drug res36: Other ADDs
86969020 Multilex Mirtazapine 30mg orodispersible tablets drug res36: Other ADDs
86971020 Multilex Zispin SolTab 30mg orodispersible tablets (Merck Sharp & Dohme Ltd) drug res36: Other ADDs
87476020 Multilex Mirtazapine 15mg orodispersible tablets drug res36: Other ADDs
87478020 Multilex Mirtazapine 45mg orodispersible tablets drug res36: Other ADDs
87480020 Multilex Zispin SolTab 15mg orodispersible tablets (Merck Sharp & Dohme Ltd) drug res36: Other ADDs
87482020 Multilex Zispin SolTab 45mg orodispersible tablets (Merck Sharp & Dohme Ltd) drug res36: Other ADDs
87990020 Multilex Mirtazapine 15mg/ml oral solution sugar free drug res36: Other ADDs
88845020 Multilex Duloxetine 30mg gastro-resistant capsules drug res36: Other ADDs
88847020 Multilex Duloxetine 60mg gastro-resistant capsules drug res36: Other ADDs
88849020 Multilex Cymbalta 30mg gastro-resistant capsules (Eli Lilly and Company Ltd) drug res36: Other ADDs
88851020 Multilex Cymbalta 60mg gastro-resistant capsules (Eli Lilly and Company Ltd) drug res36: Other ADDs
88879020 Multilex Mirtazapine 15mg tablets drug res36: Other ADDs
88881020 Multilex Mirtazapine 45mg tablets drug res36: Other ADDs
89954020 Multilex Venlafaxine 37.5mg/5ml oral suspension drug res36: Other ADDs
96239020 Multilex Rodomel XL 75mg capsules (Teva UK Ltd) drug res36: Other ADDs
96241020 Multilex Rodomel XL 150mg capsules (Teva UK Ltd) drug res36: Other ADDs
96329020 Multilex Tardcaps XL 75mg capsules (IXL Pharma Ltd) drug res36: Other ADDs
96331020 Multilex Tardcaps XL 150mg capsules (IXL Pharma Ltd) drug res36: Other ADDs
96355020 Multilex Vensir XL 75mg capsules (Morningside Healthcare Ltd) drug res36: Other ADDs
96357020 Multilex Vensir XL 150mg capsules (Morningside Healthcare Ltd) drug res36: Other ADDs
96439020 Multilex ViePax 37.5mg tablets (Dexcel-Pharma Ltd) drug res36: Other ADDs
96441020 Multilex ViePax 75mg tablets (Dexcel-Pharma Ltd) drug res36: Other ADDs
96445020 Multilex Venlafaxine 75mg modified-release tablets drug res36: Other ADDs
96447020 Multilex Venlafaxine 150mg modified-release tablets drug res36: Other ADDs
96449020 Multilex ViePax XL 75mg tablets (Dexcel-Pharma Ltd) drug res36: Other ADDs
96451020 Multilex ViePax XL 150mg tablets (Dexcel-Pharma Ltd) drug res36: Other ADDs
96465020 Multilex Tifaxin XL 75mg capsules (Genus Pharmaceuticals Ltd) drug res36: Other ADDs
96467020 Multilex Tifaxin XL 150mg capsules (Genus Pharmaceuticals Ltd) drug res36: Other ADDs
96473020 Multilex Politid XL 75mg capsules (Actavis UK Ltd) drug res36: Other ADDs
96475020 Multilex Politid XL 150mg capsules (Actavis UK Ltd) drug res36: Other ADDs
96534020 Multilex Vexarin XL 75mg capsules (Generics (UK) Ltd) drug res36: Other ADDs
96536020 Multilex Vexarin XL 150mg capsules (Generics (UK) Ltd) drug res36: Other ADDs
96614020 Multilex Venlafaxine 75mg modified-release capsules (Sandoz Ltd) drug res36: Other ADDs
96616020 Multilex Venlafaxine 150mg modified-release capsules (Sandoz Ltd) drug res36: Other ADDs
96834020 Multilex Venlalic XL 75mg tablets (DB Ashbourne Ltd) drug res36: Other ADDs
96836020 Multilex Venlalic XL 150mg tablets (DB Ashbourne Ltd) drug res36: Other ADDs
96838020 Multilex Venlafaxine 225mg modified-release tablets drug res36: Other ADDs
96841020 Multilex Venlalic XL 225mg tablets (DB Ashbourne Ltd) drug res36: Other ADDs
97003020 Multilex Venaxx XL 75mg capsules (AMCo) drug res36: Other ADDs
97005020 Multilex Venaxx XL 150mg capsules (AMCo) drug res36: Other ADDs
97028020 Multilex Agomelatine 25mg tablets drug res36: Other ADDs
97030020 Multilex Valdoxan 25mg tablets (Servier Laboratories Ltd) drug res36: Other ADDs
97351020 Multilex Foraven XL 75mg capsules (Forum Products Ltd) drug res36: Other ADDs
97656020 Multilex Ranfaxine XL 75mg capsules (Ranbaxy (UK) Ltd) drug res36: Other ADDs
98348020 Multilex Tonpular XL 75mg capsules (Wockhardt UK Ltd) drug res36: Other ADDs
98861020 Multilex Depefex XL 75mg capsules (Chiesi Ltd) drug res36: Other ADDs
98863020 Multilex Depefex XL 150mg capsules (Chiesi Ltd) drug res36: Other ADDs
99208020 Multilex Venlaneo XL 75mg capsules (Kent Pharmaceuticals Ltd) drug res36: Other ADDs
99210020 Multilex Venlaneo XL 150mg capsules (Kent Pharmaceuticals Ltd) drug res36: Other ADDs
99679020 Multilex Venlafaxine 37.5mg modified-release tablets drug res36: Other ADDs
99681020 Multilex Venlalic XL 37.5mg tablets (DB Ashbourne Ltd) drug res36: Other ADDs

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