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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: Personality disorder
78 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| E21..00 | Read | Personality disorders | diagnostic | res36: Personality disorder | |||
| E210.00 | Read | Paranoid personality disorder | diagnostic | res36: Personality disorder | |||
| E211.00 | Read | Affective personality disorder | diagnostic | res36: Personality disorder | |||
| E211000 | Read | Unspecified affective personality disorder | diagnostic | res36: Personality disorder | |||
| E21..11 | Read | Neurotic personality disorder | diagnostic | res36: Personality disorder | |||
| E211100 | Read | Hypomanic personality disorder | diagnostic | res36: Personality disorder | |||
| E211200 | Read | Depressive personality disorder | diagnostic | res36: Personality disorder | |||
| E211300 | Read | Cyclothymic personality disorder | diagnostic | res36: Personality disorder | |||
| E211z00 | Read | Affective personality disorder NOS | diagnostic | res36: Personality disorder | |||
| E212.00 | Read | Schizoid personality disorder | diagnostic | res36: Personality disorder | |||
| E212000 | Read | Unspecified schizoid personality disorder | diagnostic | res36: Personality disorder | |||
| E212z00 | Read | Schizoid personality disorder NOS | diagnostic | res36: Personality disorder | |||
| E213.00 | Read | Explosive personality disorder | diagnostic | res36: Personality disorder | |||
| E214.00 | Read | Compulsive personality disorders | diagnostic | res36: Personality disorder | |||
| E214000 | Read | Anankastic personality | diagnostic | res36: Personality disorder | |||
| E214.11 | Read | Anancastic personality | diagnostic | res36: Personality disorder | |||
| E214z00 | Read | Compulsive personality disorder NOS | diagnostic | res36: Personality disorder | |||
| E215.00 | Read | Histrionic personality disorders | diagnostic | res36: Personality disorder | |||
| E215000 | Read | Unspecified histrionic personality disorder | diagnostic | res36: Personality disorder | |||
| E215.11 | Read | Hysterical personality disorders | diagnostic | res36: Personality disorder | |||
| E215z00 | Read | Histrionic personality disorder NOS | diagnostic | res36: Personality disorder | |||
| E216.00 | Read | Inadequate personality disorder | diagnostic | res36: Personality disorder | |||
| E217.00 | Read | Antisocial or sociopathic personality disorder | diagnostic | res36: Personality disorder | |||
| E21y.00 | Read | Other personality disorders | diagnostic | res36: Personality disorder | |||
| E21y000 | Read | Narcissistic personality disorder | diagnostic | res36: Personality disorder | |||
| E21y100 | Read | Avoidant personality disorder | diagnostic | res36: Personality disorder | |||
| E21y200 | Read | Borderline personality disorder | diagnostic | res36: Personality disorder | |||
| E21y300 | Read | Passive-aggressive personality disorder | diagnostic | res36: Personality disorder | |||
| E21y400 | Read | Eccentric personality disorder | diagnostic | res36: Personality disorder | |||
| E21y500 | Read | Immature personality disorder | diagnostic | res36: Personality disorder | |||
| E21y600 | Read | Masochistic personality disorder | diagnostic | res36: Personality disorder | |||
| E21y700 | Read | Psychoneurotic personality disorder | diagnostic | res36: Personality disorder | |||
| E21yz00 | Read | Other personality disorder NOS | diagnostic | res36: Personality disorder | |||
| E21z.00 | Read | Personality disorder NOS | diagnostic | res36: Personality disorder | |||
| E21z.11 | Read | Psychopathic personality | diagnostic | res36: Personality disorder | |||
| Eu06000 | Read | [X]Organic personality disorder | diagnostic | res36: Personality disorder | |||
| Eu06011 | Read | [X]Organic pseudopsychopathic personality | diagnostic | res36: Personality disorder | |||
| Eu21.17 | Read | [X]Pseudopsychopathic schizophrenia | diagnostic | res36: Personality disorder | |||
| Eu21.18 | Read | [X]Schizotypal personality disorder | diagnostic | res36: Personality disorder | |||
| Eu34011 | Read | [X]Affective personality disorder | diagnostic | res36: Personality disorder | |||
| Eu34112 | Read | [X]Depressive personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60.00 | Read | [X]Specific personality disorders | diagnostic | res36: Personality disorder | |||
| Eu60000 | Read | [X]Paranoid personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60013 | Read | [X]Querulant personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60014 | Read | [X]Sensitive paranoid personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60100 | Read | [X]Schizoid personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60200 | Read | [X]Dissocial personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60212 | Read | [X]Antisocial personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60213 | Read | [X]Asocial personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60214 | Read | [X]Psychopathic personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60215 | Read | [X]Sociopathic personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60300 | Read | [X]Emotionally unstable personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60311 | Read | [X]Aggressive personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60312 | Read | [X]Borderline personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60313 | Read | [X]Explosive personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60400 | Read | [X]Histrionic personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60411 | Read | [X]Hysterical personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60412 | Read | [X]Psychoinfantile personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60500 | Read | [X]Anankastic personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60511 | Read | [X]Compulsive personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60512 | Read | [X]Obsessional personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60513 | Read | [X]Obsessive-compulsive personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60600 | Read | [X]Anxious [avoidant] personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60700 | Read | [X]Dependent personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60711 | Read | [X]Asthenic personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60712 | Read | [X]Inadequate personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60713 | Read | [X]Passive personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60714 | Read | [X]Self defeating personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60y00 | Read | [X]Other specific personality disorders | diagnostic | res36: Personality disorder | |||
| Eu60y11 | Read | [X]Eccentric personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60y12 | Read | [X]Haltlose type personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60y13 | Read | [X]Immature personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60y14 | Read | [X]Narcissistic personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60y16 | Read | [X]Psychoneurotic personality disorder | diagnostic | res36: Personality disorder | |||
| Eu60z00 | Read | [X]Personality disorder, unspecified | diagnostic | res36: Personality disorder | |||
| Eu61.00 | Read | [X]Mixed and other personality disorders | diagnostic | res36: Personality disorder | |||
| Eu84511 | Read | [X]Autistic psychopathy | diagnostic | res36: Personality disorder | |||
| Eu94211 | Read | [X]Affectionless psychopathy | diagnostic | res36: Personality disorder |
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