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Research article:
Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary care patients
Reference:
Kirsten Windfuhr, David While, Nav Kapur, Darren M. Ashcroft, Evangelos Kontopantelis, Matthew J. Carr, Jenny Shaw, Louis Appleby, Roger T. Webb (2016) Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary care patients. Psychological Medicine, doi:
- Link to article
- Abstract
- Background: Little is known about the precursors of suicide risk among primary care patients. Objectives: To examine risk of suicide in relation to recent general practice consultation patterns, psychiatric diagnoses and the prescribing of multiple psychotropic drug types. Methods: Nested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged 16 years and older who died by suicide during 2002-2011 (N=2384) were matched on gender, age and registered practice with up to 20 living control patients (N=46,899). Results: Risk of dying by suicide was raised among general practice non-attenders, and increased sharply with rising number of clinical consultations compared with patients who consulted once only in the year preceding suicide. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types and with having several psychiatric diagnoses, and to a lesser degree risk was also raised among patients living in more socially deprived residential areas. In a multivariable model the confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing clinical consultation frequency. Conclusion: A greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-attenders are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties and at elevated risk of suicide.
- Author for correspondence
- Roger Webb
- Email for correspondence
- roger.webb@manchester.ac.uk
Code list: res38: Bipolar disorder
111 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 146D.00 | Read | H/O: manic depressive disorder | diagnostic | res38: Bipolar disorder | |||
| 1S42.00 | Read | Manic mood | diagnostic | res38: Bipolar disorder | |||
| 6657.00 | Read | On lithium | diagnostic | res38: Bipolar disorder | |||
| 6657.11 | Read | Lithium monitoring | diagnostic | res38: Bipolar disorder | |||
| 6657.12 | Read | Started lithium | diagnostic | res38: Bipolar disorder | |||
| E11..00 | Read | Affective psychoses | diagnostic | res38: Bipolar disorder | |||
| E110.00 | Read | Manic disorder, single episode | diagnostic | res38: Bipolar disorder | |||
| E110000 | Read | Single manic episode, unspecified | diagnostic | res38: Bipolar disorder | |||
| E110100 | Read | Single manic episode, mild | diagnostic | res38: Bipolar disorder | |||
| E110.11 | Read | Hypomanic psychoses | diagnostic | res38: Bipolar disorder | |||
| E110200 | Read | Single manic episode, moderate | diagnostic | res38: Bipolar disorder | |||
| E110300 | Read | Single manic episode, severe without mention of psychosis | diagnostic | res38: Bipolar disorder | |||
| E110400 | Read | Single manic episode, severe, with psychosis | diagnostic | res38: Bipolar disorder | |||
| E110600 | Read | Single manic episode in full remission | diagnostic | res38: Bipolar disorder | |||
| E110z00 | Read | Manic disorder, single episode NOS | diagnostic | res38: Bipolar disorder | |||
| E111.00 | Read | Recurrent manic episodes | diagnostic | res38: Bipolar disorder | |||
| E111000 | Read | Recurrent manic episodes, unspecified | diagnostic | res38: Bipolar disorder | |||
| E11..11 | Read | Bipolar psychoses | diagnostic | res38: Bipolar disorder | |||
| E111100 | Read | Recurrent manic episodes, mild | diagnostic | res38: Bipolar disorder | |||
| E111200 | Read | Recurrent manic episodes, moderate | diagnostic | res38: Bipolar disorder | |||
| E11..13 | Read | Manic psychoses | diagnostic | res38: Bipolar disorder | |||
| E111300 | Read | Recurrent manic episodes, severe without mention psychosis | diagnostic | res38: Bipolar disorder | |||
| E111400 | Read | Recurrent manic episodes, severe, with psychosis | diagnostic | res38: Bipolar disorder | |||
| E111500 | Read | Recurrent manic episodes, partial or unspecified remission | diagnostic | res38: Bipolar disorder | |||
| E111600 | Read | Recurrent manic episodes, in full remission | diagnostic | res38: Bipolar disorder | |||
| E111z00 | Read | Recurrent manic episode NOS | diagnostic | res38: Bipolar disorder | |||
| E114.00 | Read | Bipolar affective disorder, currently manic | diagnostic | res38: Bipolar disorder | |||
| E114000 | Read | Bipolar affective disorder, currently manic, unspecified | diagnostic | res38: Bipolar disorder | |||
| E114100 | Read | Bipolar affective disorder, currently manic, mild | diagnostic | res38: Bipolar disorder | |||
| E114.11 | Read | Manic-depressive - now manic | diagnostic | res38: Bipolar disorder | |||
| E114200 | Read | Bipolar affective disorder, currently manic, moderate | diagnostic | res38: Bipolar disorder | |||
| E114300 | Read | Bipolar affect disord, currently manic, severe, no psychosis | diagnostic | res38: Bipolar disorder | |||
| E114400 | Read | Bipolar affect disord, currently manic,severe with psychosis | diagnostic | res38: Bipolar disorder | |||
| E114500 | Read | Bipolar affect disord,currently manic, part/unspec remission | diagnostic | res38: Bipolar disorder | |||
| E114600 | Read | Bipolar affective disorder, currently manic, full remission | diagnostic | res38: Bipolar disorder | |||
| E114z00 | Read | Bipolar affective disorder, currently manic, NOS | diagnostic | res38: Bipolar disorder | |||
| E115.00 | Read | Bipolar affective disorder, currently depressed | diagnostic | res38: Bipolar disorder | |||
| E115000 | Read | Bipolar affective disorder, currently depressed, unspecified | diagnostic | res38: Bipolar disorder | |||
| E115100 | Read | Bipolar affective disorder, currently depressed, mild | diagnostic | res38: Bipolar disorder | |||
| E115.11 | Read | Manic-depressive - now depressed | diagnostic | res38: Bipolar disorder | |||
| E115200 | Read | Bipolar affective disorder, currently depressed, moderate | diagnostic | res38: Bipolar disorder | |||
| E115300 | Read | Bipolar affect disord, now depressed, severe, no psychosis | diagnostic | res38: Bipolar disorder | |||
| E115400 | Read | Bipolar affect disord, now depressed, severe with psychosis | diagnostic | res38: Bipolar disorder | |||
| E115500 | Read | Bipolar affect disord, now depressed, part/unspec remission | diagnostic | res38: Bipolar disorder | |||
| E115600 | Read | Bipolar affective disorder, now depressed, in full remission | diagnostic | res38: Bipolar disorder | |||
| E115z00 | Read | Bipolar affective disorder, currently depressed, NOS | diagnostic | res38: Bipolar disorder | |||
| E116.00 | Read | Mixed bipolar affective disorder | diagnostic | res38: Bipolar disorder | |||
| E116000 | Read | Mixed bipolar affective disorder, unspecified | diagnostic | res38: Bipolar disorder | |||
| E116100 | Read | Mixed bipolar affective disorder, mild | diagnostic | res38: Bipolar disorder | |||
| E116200 | Read | Mixed bipolar affective disorder, moderate | diagnostic | res38: Bipolar disorder | |||
| E116300 | Read | Mixed bipolar affective disorder, severe, without psychosis | diagnostic | res38: Bipolar disorder | |||
| E116400 | Read | Mixed bipolar affective disorder, severe, with psychosis | diagnostic | res38: Bipolar disorder | |||
| E116500 | Read | Mixed bipolar affective disorder, partial/unspec remission | diagnostic | res38: Bipolar disorder | |||
| E116600 | Read | Mixed bipolar affective disorder, in full remission | diagnostic | res38: Bipolar disorder | |||
| E116z00 | Read | Mixed bipolar affective disorder, NOS | diagnostic | res38: Bipolar disorder | |||
| E117.00 | Read | Unspecified bipolar affective disorder | diagnostic | res38: Bipolar disorder | |||
| E117000 | Read | Unspecified bipolar affective disorder, unspecified | diagnostic | res38: Bipolar disorder | |||
| E117100 | Read | Unspecified bipolar affective disorder, mild | diagnostic | res38: Bipolar disorder | |||
| E117200 | Read | Unspecified bipolar affective disorder, moderate | diagnostic | res38: Bipolar disorder | |||
| E117300 | Read | Unspecified bipolar affective disorder, severe, no psychosis | diagnostic | res38: Bipolar disorder | |||
| E117400 | Read | Unspecified bipolar affective disorder,severe with psychosis | diagnostic | res38: Bipolar disorder | |||
| E117500 | Read | Unspecified bipolar affect disord, partial/unspec remission | diagnostic | res38: Bipolar disorder | |||
| E117600 | Read | Unspecified bipolar affective disorder, in full remission | diagnostic | res38: Bipolar disorder | |||
| E117z00 | Read | Unspecified bipolar affective disorder, NOS | diagnostic | res38: Bipolar disorder | |||
| E11y.00 | Read | Other and unspecified manic-depressive psychoses | diagnostic | res38: Bipolar disorder | |||
| E11y000 | Read | Unspecified manic-depressive psychoses | diagnostic | res38: Bipolar disorder | |||
| E11y100 | Read | Atypical manic disorder | diagnostic | res38: Bipolar disorder | |||
| E11y300 | Read | Other mixed manic-depressive psychoses | diagnostic | res38: Bipolar disorder | |||
| E11yz00 | Read | Other and unspecified manic-depressive psychoses NOS | diagnostic | res38: Bipolar disorder | |||
| Eu3..00 | Read | [X]Mood - affective disorders | diagnostic | res38: Bipolar disorder | |||
| Eu30.00 | Read | [X]Manic episode | diagnostic | res38: Bipolar disorder | |||
| Eu30000 | Read | [X]Hypomania | diagnostic | res38: Bipolar disorder | |||
| Eu30100 | Read | [X]Mania without psychotic symptoms | diagnostic | res38: Bipolar disorder | |||
| Eu30.11 | Read | [X]Bipolar disorder, single manic episode | diagnostic | res38: Bipolar disorder | |||
| Eu30200 | Read | [X]Mania with psychotic symptoms | diagnostic | res38: Bipolar disorder | |||
| Eu30211 | Read | [X]Mania with mood-congruent psychotic symptoms | diagnostic | res38: Bipolar disorder | |||
| Eu30212 | Read | [X]Mania with mood-incongruent psychotic symptoms | diagnostic | res38: Bipolar disorder | |||
| Eu30y00 | Read | [X]Other manic episodes | diagnostic | res38: Bipolar disorder | |||
| Eu30z00 | Read | [X]Manic episode, unspecified | diagnostic | res38: Bipolar disorder | |||
| Eu30z11 | Read | [X]Mania NOS | diagnostic | res38: Bipolar disorder | |||
| Eu31.00 | Read | [X]Bipolar affective disorder | diagnostic | res38: Bipolar disorder | |||
| Eu31000 | Read | [X]Bipolar affective disorder, current episode hypomanic | diagnostic | res38: Bipolar disorder | |||
| Eu31100 | Read | [X]Bipolar affect disorder cur epi manic wout psychotic symp | diagnostic | res38: Bipolar disorder | |||
| Eu31.11 | Read | [X]Manic-depressive illness | diagnostic | res38: Bipolar disorder | |||
| Eu31.12 | Read | [X]Manic-depressive psychosis | diagnostic | res38: Bipolar disorder | |||
| Eu31.13 | Read | [X]Manic-depressive reaction | diagnostic | res38: Bipolar disorder | |||
| Eu31200 | Read | [X]Bipolar affect disorder cur epi manic with psychotic symp | diagnostic | res38: Bipolar disorder | |||
| Eu31300 | Read | [X]Bipolar affect disorder cur epi mild or moderate depressn | diagnostic | res38: Bipolar disorder | |||
| Eu31400 | Read | [X]Bipol aff disord, curr epis sev depress, no psychot symp | diagnostic | res38: Bipolar disorder | |||
| Eu31500 | Read | [X]Bipolar affect dis cur epi severe depres with psyc symp | diagnostic | res38: Bipolar disorder | |||
| Eu31600 | Read | [X]Bipolar affective disorder, current episode mixed | diagnostic | res38: Bipolar disorder | |||
| Eu31700 | Read | [X]Bipolar affective disorder, currently in remission | diagnostic | res38: Bipolar disorder | |||
| Eu31y00 | Read | [X]Other bipolar affective disorders | diagnostic | res38: Bipolar disorder | |||
| Eu31y11 | Read | [X]Bipolar II disorder | diagnostic | res38: Bipolar disorder | |||
| Eu31y12 | Read | [X]Recurrent manic episodes | diagnostic | res38: Bipolar disorder | |||
| Eu31z00 | Read | [X]Bipolar affective disorder, unspecified | diagnostic | res38: Bipolar disorder | |||
| Eu33213 | Read | [X]Manic-depress psychosis,depressd,no psychotic symptoms | diagnostic | res38: Bipolar disorder | |||
| Eu33312 | Read | [X]Manic-depress psychosis,depressed type+psychotic symptoms | diagnostic | res38: Bipolar disorder | |||
| Eu34.00 | Read | [X]Persistent mood affective disorders | diagnostic | res38: Bipolar disorder | |||
| Eu34000 | Read | [X]Cyclothymia | diagnostic | res38: Bipolar disorder | |||
| Eu34y00 | Read | [X]Other persistent mood affective disorders | diagnostic | res38: Bipolar disorder | |||
| Eu34z00 | Read | [X]Persistent mood affective disorder, unspecified | diagnostic | res38: Bipolar disorder | |||
| Eu3y.00 | Read | [X]Other mood affective disorders | diagnostic | res38: Bipolar disorder | |||
| Eu3y000 | Read | [X]Other single mood affective disorders | diagnostic | res38: Bipolar disorder | |||
| Eu3y011 | Read | [X]Mixed affective episode | diagnostic | res38: Bipolar disorder | |||
| Eu3y100 | Read | [X]Other recurrent mood affective disorders | diagnostic | res38: Bipolar disorder | |||
| Eu3yy00 | Read | [X]Other specified mood affective disorders | diagnostic | res38: Bipolar disorder | |||
| Eu3z.00 | Read | [X]Unspecified mood affective disorder | diagnostic | res38: Bipolar disorder | |||
| Eu3z.11 | Read | [X]Affective psychosis NOS | diagnostic | res38: Bipolar disorder | |||
| ZV11111 | Read | [V]Personal history of manic-depressive psychosis | diagnostic | res38: Bipolar disorder | |||
| ZV11112 | Read | [V]Personal history of manic-depressive psychosis | diagnostic | res38: Bipolar disorder |
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