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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: Schizophrenia spectrum

194 codes in list

Code Coding system Description Entity type List name
1464.00 Read H/O: schizophrenia diagnostic res36: Schizophrenia spectrum
146H.00 Read H/O: psychosis diagnostic res36: Schizophrenia spectrum
1BH..00 Read Delusions diagnostic res36: Schizophrenia spectrum
1BH0.00 Read Delusion of persecution diagnostic res36: Schizophrenia spectrum
1BH1.00 Read Grandiose delusions diagnostic res36: Schizophrenia spectrum
1BH..11 Read Delusion diagnostic res36: Schizophrenia spectrum
1BH2.00 Read Ideas of reference diagnostic res36: Schizophrenia spectrum
1BH3.00 Read Paranoid ideation diagnostic res36: Schizophrenia spectrum
225E.00 Read O/E - paranoid delusions diagnostic res36: Schizophrenia spectrum
225F.00 Read O/E - delusion of persecution diagnostic res36: Schizophrenia spectrum
285..11 Read Psychotic condition, insight present diagnostic res36: Schizophrenia spectrum
286..11 Read Poor insight into psychotic condition diagnostic res36: Schizophrenia spectrum
665E.00 Read Injectable neuroleptic given diagnostic res36: Schizophrenia spectrum
665F.00 Read On injectable neuroleptic diagnostic res36: Schizophrenia spectrum
E1...00 Read Non-organic psychoses diagnostic res36: Schizophrenia spectrum
E10..00 Read Schizophrenic disorders diagnostic res36: Schizophrenia spectrum
E100.00 Read Simple schizophrenia diagnostic res36: Schizophrenia spectrum
E100000 Read Unspecified schizophrenia diagnostic res36: Schizophrenia spectrum
E100100 Read Subchronic schizophrenia diagnostic res36: Schizophrenia spectrum
E100.11 Read Schizophrenia simplex diagnostic res36: Schizophrenia spectrum
E100200 Read Chronic schizophrenic diagnostic res36: Schizophrenia spectrum
E100300 Read Acute exacerbation of subchronic schizophrenia diagnostic res36: Schizophrenia spectrum
E100400 Read Acute exacerbation of chronic schizophrenia diagnostic res36: Schizophrenia spectrum
E100500 Read Schizophrenia in remission diagnostic res36: Schizophrenia spectrum
E100z00 Read Simple schizophrenia NOS diagnostic res36: Schizophrenia spectrum
E101.00 Read Hebephrenic schizophrenia diagnostic res36: Schizophrenia spectrum
E101000 Read Unspecified hebephrenic schizophrenia diagnostic res36: Schizophrenia spectrum
E101400 Read Acute exacerbation of chronic hebephrenic schizophrenia diagnostic res36: Schizophrenia spectrum
E101500 Read Hebephrenic schizophrenia in remission diagnostic res36: Schizophrenia spectrum
E101z00 Read Hebephrenic schizophrenia NOS diagnostic res36: Schizophrenia spectrum
E102.00 Read Catatonic schizophrenia diagnostic res36: Schizophrenia spectrum
E102000 Read Unspecified catatonic schizophrenia diagnostic res36: Schizophrenia spectrum
E102100 Read Subchronic catatonic schizophrenia diagnostic res36: Schizophrenia spectrum
E102500 Read Catatonic schizophrenia in remission diagnostic res36: Schizophrenia spectrum
E102z00 Read Catatonic schizophrenia NOS diagnostic res36: Schizophrenia spectrum
E103.00 Read Paranoid schizophrenia diagnostic res36: Schizophrenia spectrum
E103000 Read Unspecified paranoid schizophrenia diagnostic res36: Schizophrenia spectrum
E103200 Read Chronic paranoid schizophrenia diagnostic res36: Schizophrenia spectrum
E103300 Read Acute exacerbation of subchronic paranoid schizophrenia diagnostic res36: Schizophrenia spectrum
E103400 Read Acute exacerbation of chronic paranoid schizophrenia diagnostic res36: Schizophrenia spectrum
E103500 Read Paranoid schizophrenia in remission diagnostic res36: Schizophrenia spectrum
E103z00 Read Paranoid schizophrenia NOS diagnostic res36: Schizophrenia spectrum
E104.00 Read Acute schizophrenic episode diagnostic res36: Schizophrenia spectrum
E105.00 Read Latent schizophrenia diagnostic res36: Schizophrenia spectrum
E105000 Read Unspecified latent schizophrenia diagnostic res36: Schizophrenia spectrum
E105200 Read Chronic latent schizophrenia diagnostic res36: Schizophrenia spectrum
E105500 Read Latent schizophrenia in remission diagnostic res36: Schizophrenia spectrum
E105z00 Read Latent schizophrenia NOS diagnostic res36: Schizophrenia spectrum
E106.00 Read Residual schizophrenia diagnostic res36: Schizophrenia spectrum
E107.00 Read Schizo-affective schizophrenia diagnostic res36: Schizophrenia spectrum
E107000 Read Unspecified schizo-affective schizophrenia diagnostic res36: Schizophrenia spectrum
E107100 Read Subchronic schizo-affective schizophrenia diagnostic res36: Schizophrenia spectrum
E107.11 Read Cyclic schizophrenia diagnostic res36: Schizophrenia spectrum
E107200 Read Chronic schizo-affective schizophrenia diagnostic res36: Schizophrenia spectrum
E107300 Read Acute exacerbation subchronic schizo-affective schizophrenia diagnostic res36: Schizophrenia spectrum
E107400 Read Acute exacerbation of chronic schizo-affective schizophrenia diagnostic res36: Schizophrenia spectrum
E107500 Read Schizo-affective schizophrenia in remission diagnostic res36: Schizophrenia spectrum
E107z00 Read Schizo-affective schizophrenia NOS diagnostic res36: Schizophrenia spectrum
E10y.00 Read Other schizophrenia diagnostic res36: Schizophrenia spectrum
E10y000 Read Atypical schizophrenia diagnostic res36: Schizophrenia spectrum
E10y100 Read Coenesthopathic schizophrenia diagnostic res36: Schizophrenia spectrum
E10y.11 Read Cenesthopathic schizophrenia diagnostic res36: Schizophrenia spectrum
E10yz00 Read Other schizophrenia NOS diagnostic res36: Schizophrenia spectrum
E10z.00 Read Schizophrenia NOS diagnostic res36: Schizophrenia spectrum
E11z.00 Read Other and unspecified affective psychoses diagnostic res36: Schizophrenia spectrum
E11z000 Read Unspecified affective psychoses NOS diagnostic res36: Schizophrenia spectrum
E11zz00 Read Other affective psychosis NOS diagnostic res36: Schizophrenia spectrum
E12..00 Read Paranoid states diagnostic res36: Schizophrenia spectrum
E120.00 Read Simple paranoid state diagnostic res36: Schizophrenia spectrum
E121.00 Read Chronic paranoid psychosis diagnostic res36: Schizophrenia spectrum
E122.00 Read Paraphrenia diagnostic res36: Schizophrenia spectrum
E123.00 Read Shared paranoid disorder diagnostic res36: Schizophrenia spectrum
E12y.00 Read Other paranoid states diagnostic res36: Schizophrenia spectrum
E12y000 Read Paranoia querulans diagnostic res36: Schizophrenia spectrum
E12yz00 Read Other paranoid states NOS diagnostic res36: Schizophrenia spectrum
E12z.00 Read Paranoid psychosis NOS diagnostic res36: Schizophrenia spectrum
E13..00 Read Other nonorganic psychoses diagnostic res36: Schizophrenia spectrum
E130.00 Read Reactive depressive psychosis diagnostic res36: Schizophrenia spectrum
E130.11 Read Psychotic reactive depression diagnostic res36: Schizophrenia spectrum
E131.00 Read Acute hysterical psychosis diagnostic res36: Schizophrenia spectrum
E13..11 Read Reactive psychoses diagnostic res36: Schizophrenia spectrum
E133.00 Read Acute paranoid reaction diagnostic res36: Schizophrenia spectrum
E134.00 Read Psychogenic paranoid psychosis diagnostic res36: Schizophrenia spectrum
E13y.00 Read Other reactive psychoses diagnostic res36: Schizophrenia spectrum
E13y100 Read Brief reactive psychosis diagnostic res36: Schizophrenia spectrum
E13yz00 Read Other reactive psychoses NOS diagnostic res36: Schizophrenia spectrum
E13z.00 Read Nonorganic psychosis NOS diagnostic res36: Schizophrenia spectrum
E13z.11 Read Psychotic episode NOS diagnostic res36: Schizophrenia spectrum
E14..00 Read Psychoses with origin in childhood diagnostic res36: Schizophrenia spectrum
E141.00 Read Disintegrative psychosis diagnostic res36: Schizophrenia spectrum
E141100 Read Residual disintegrative psychoses diagnostic res36: Schizophrenia spectrum
E141.11 Read Heller's syndrome diagnostic res36: Schizophrenia spectrum
E1y..00 Read Other specified non-organic psychoses diagnostic res36: Schizophrenia spectrum
E1z..00 Read Non-organic psychosis NOS diagnostic res36: Schizophrenia spectrum
Eu02z12 Read [X] Presenile psychosis NOS diagnostic res36: Schizophrenia spectrum
Eu0z.12 Read [X]Symptomatic psychosis NOS diagnostic res36: Schizophrenia spectrum
Eu2..00 Read [X]Schizophrenia, schizotypal and delusional disorders diagnostic res36: Schizophrenia spectrum
Eu20.00 Read [X]Schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20000 Read [X]Paranoid schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20011 Read [X]Paraphrenic schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20100 Read [X]Hebephrenic schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20111 Read [X]Disorganised schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20200 Read [X]Catatonic schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20211 Read [X]Catatonic stupor diagnostic res36: Schizophrenia spectrum
Eu20212 Read [X]Schizophrenic catalepsy diagnostic res36: Schizophrenia spectrum
Eu20213 Read [X]Schizophrenic catatonia diagnostic res36: Schizophrenia spectrum
Eu20214 Read [X]Schizophrenic flexibilatis cerea diagnostic res36: Schizophrenia spectrum
Eu20300 Read [X]Undifferentiated schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20311 Read [X]Atypical schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20500 Read [X]Residual schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20511 Read [X]Chronic undifferentiated schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20600 Read [X]Simple schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20y00 Read [X]Other schizophrenia diagnostic res36: Schizophrenia spectrum
Eu20y12 Read [X]Schizophreniform disord NOS diagnostic res36: Schizophrenia spectrum
Eu20y13 Read [X]Schizophrenifrm psychos NOS diagnostic res36: Schizophrenia spectrum
Eu20z00 Read [X]Schizophrenia, unspecified diagnostic res36: Schizophrenia spectrum
Eu21.00 Read [X]Schizotypal disorder diagnostic res36: Schizophrenia spectrum
Eu21.11 Read [X]Latent schizophrenic reaction diagnostic res36: Schizophrenia spectrum
Eu21.12 Read [X]Borderline schizophrenia diagnostic res36: Schizophrenia spectrum
Eu21.13 Read [X]Latent schizophrenia diagnostic res36: Schizophrenia spectrum
Eu21.14 Read [X]Prepsychotic schizophrenia diagnostic res36: Schizophrenia spectrum
Eu21.15 Read [X]Prodromal schizophrenia diagnostic res36: Schizophrenia spectrum
Eu21.16 Read [X]Pseudoneurotic schizophrenia diagnostic res36: Schizophrenia spectrum
Eu22.00 Read [X]Persistent delusional disorders diagnostic res36: Schizophrenia spectrum
Eu22000 Read [X]Delusional disorder diagnostic res36: Schizophrenia spectrum
Eu22011 Read [X]Paranoid psychosis diagnostic res36: Schizophrenia spectrum
Eu22012 Read [X]Paranoid state diagnostic res36: Schizophrenia spectrum
Eu22013 Read [X]Paraphrenia - late diagnostic res36: Schizophrenia spectrum
Eu22014 Read [X]Sensitiver Beziehungswahn diagnostic res36: Schizophrenia spectrum
Eu22015 Read [X]Paranoia diagnostic res36: Schizophrenia spectrum
Eu22100 Read [X]Delusional misidentification syndrome diagnostic res36: Schizophrenia spectrum
Eu22111 Read [X]Capgras syndrome diagnostic res36: Schizophrenia spectrum
Eu22y00 Read [X]Other persistent delusional disorders diagnostic res36: Schizophrenia spectrum
Eu22y11 Read [X]Delusional dysmorphophobia diagnostic res36: Schizophrenia spectrum
Eu22y12 Read [X]Involutional paranoid state diagnostic res36: Schizophrenia spectrum
Eu22y13 Read [X]Paranoia querulans diagnostic res36: Schizophrenia spectrum
Eu22z00 Read [X]Persistent delusional disorder, unspecified diagnostic res36: Schizophrenia spectrum
Eu23.00 Read [X]Acute and transient psychotic disorders diagnostic res36: Schizophrenia spectrum
Eu23000 Read [X]Acute polymorphic psychot disord without symp of schizoph diagnostic res36: Schizophrenia spectrum
Eu23012 Read [X]Cycloid psychosis diagnostic res36: Schizophrenia spectrum
Eu23100 Read [X]Acute polymorphic psychot disord with symp of schizophren diagnostic res36: Schizophrenia spectrum
Eu23112 Read [X]Cycloid psychosis with symptoms of schizophrenia diagnostic res36: Schizophrenia spectrum
Eu23200 Read [X]Acute schizophrenia-like psychotic disorder diagnostic res36: Schizophrenia spectrum
Eu23211 Read [X]Brief schizophreniform disorder diagnostic res36: Schizophrenia spectrum
Eu23212 Read [X]Brief schizophrenifrm psych diagnostic res36: Schizophrenia spectrum
Eu23214 Read [X]Schizophrenic reaction diagnostic res36: Schizophrenia spectrum
Eu23300 Read [X]Other acute predominantly delusional psychotic disorders diagnostic res36: Schizophrenia spectrum
Eu23312 Read [X]Psychogenic paranoid psychosis diagnostic res36: Schizophrenia spectrum
Eu23y00 Read [X]Other acute and transient psychotic disorders diagnostic res36: Schizophrenia spectrum
Eu23z00 Read [X]Acute and transient psychotic disorder, unspecified diagnostic res36: Schizophrenia spectrum
Eu23z11 Read [X]Brief reactive psychosis NOS diagnostic res36: Schizophrenia spectrum
Eu23z12 Read [X]Reactive psychosis diagnostic res36: Schizophrenia spectrum
Eu25.00 Read [X]Schizoaffective disorders diagnostic res36: Schizophrenia spectrum
Eu25000 Read [X]Schizoaffective disorder, manic type diagnostic res36: Schizophrenia spectrum
Eu25011 Read [X]Schizoaffective psychosis, manic type diagnostic res36: Schizophrenia spectrum
Eu25012 Read [X]Schizophreniform psychosis, manic type diagnostic res36: Schizophrenia spectrum
Eu25100 Read [X]Schizoaffective disorder, depressive type diagnostic res36: Schizophrenia spectrum
Eu25111 Read [X]Schizoaffective psychosis, depressive type diagnostic res36: Schizophrenia spectrum
Eu25112 Read [X]Schizophreniform psychosis, depressive type diagnostic res36: Schizophrenia spectrum
Eu25200 Read [X]Schizoaffective disorder, mixed type diagnostic res36: Schizophrenia spectrum
Eu25212 Read [X]Mixed schizophrenic and affective psychosis diagnostic res36: Schizophrenia spectrum
Eu25y00 Read [X]Other schizoaffective disorders diagnostic res36: Schizophrenia spectrum
Eu25z00 Read [X]Schizoaffective disorder, unspecified diagnostic res36: Schizophrenia spectrum
Eu25z11 Read [X]Schizoaffective psychosis NOS diagnostic res36: Schizophrenia spectrum
Eu2y.00 Read [X]Other nonorganic psychotic disorders diagnostic res36: Schizophrenia spectrum
Eu2y.11 Read [X]Chronic hallucinatory psychosis diagnostic res36: Schizophrenia spectrum
Eu2z.00 Read [X]Unspecified nonorganic psychosis diagnostic res36: Schizophrenia spectrum
Eu2z.11 Read [X]Psychosis NOS diagnostic res36: Schizophrenia spectrum
Eu32300 Read [X]Severe depressive episode with psychotic symptoms diagnostic res36: Schizophrenia spectrum
Eu32311 Read [X]Single episode of major depression and psychotic symptoms diagnostic res36: Schizophrenia spectrum
Eu32312 Read [X]Single episode of psychogenic depressive psychosis diagnostic res36: Schizophrenia spectrum
Eu32313 Read [X]Single episode of psychotic depression diagnostic res36: Schizophrenia spectrum
Eu32314 Read [X]Single episode of reactive depressive psychosis diagnostic res36: Schizophrenia spectrum
Eu32900 Read [X]Single major depr ep, severe with psych, psych in remiss diagnostic res36: Schizophrenia spectrum
Eu32A00 Read [X]Recurr major depr ep, severe with psych, psych in remiss diagnostic res36: Schizophrenia spectrum
Eu33300 Read [X]Recurrent depress disorder cur epi severe with psyc symp diagnostic res36: Schizophrenia spectrum
Eu33311 Read [X]Endogenous depression with psychotic symptoms diagnostic res36: Schizophrenia spectrum
Eu33313 Read [X]Recurr severe episodes/major depression+psychotic symptom diagnostic res36: Schizophrenia spectrum
Eu33314 Read [X]Recurr severe episodes/psychogenic depressive psychosis diagnostic res36: Schizophrenia spectrum
Eu33315 Read [X]Recurrent severe episodes of psychotic depression diagnostic res36: Schizophrenia spectrum
Eu33316 Read [X]Recurrent severe episodes/reactive depressive psychosis diagnostic res36: Schizophrenia spectrum
Eu44.14 Read [X]Hysterical psychosis diagnostic res36: Schizophrenia spectrum
Eu84312 Read [X]Disintegrative psychosis diagnostic res36: Schizophrenia spectrum
Eu84314 Read [X]Symbiotic psychosis diagnostic res36: Schizophrenia spectrum
R001.00 Read [D]Hallucinations diagnostic res36: Schizophrenia spectrum
R001000 Read [D]Hallucinations, auditory diagnostic res36: Schizophrenia spectrum
R001100 Read [D]Hallucinations, gustatory diagnostic res36: Schizophrenia spectrum
R001200 Read [D]Hallucinations, olfactory diagnostic res36: Schizophrenia spectrum
R001300 Read [D]Hallucinations, tactile diagnostic res36: Schizophrenia spectrum
R001400 Read [D]Visual hallucinations diagnostic res36: Schizophrenia spectrum
R001z00 Read [D]Hallucinations NOS diagnostic res36: Schizophrenia spectrum
Ryu5300 Read [X]Other hallucinations diagnostic res36: Schizophrenia spectrum
ZS7C611 Read Schizophrenic language diagnostic res36: Schizophrenia spectrum
ZV11000 Read [V]Personal history of schizophrenia diagnostic res36: Schizophrenia spectrum

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