| アブストラクト | 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 6318 (15.2%, 14.9-15.6) were referred to mental health services; 4105 (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. |
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| ジャーナル名 | Journal of affective disorders |
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| Pubmed追加日 | 2016/3/20 |
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| 投稿者 | Carr, Matthew J; Ashcroft, Darren M; Kontopantelis, Evangelos; While, David; Awenat, Yvonne; Cooper, Jayne; Chew-Graham, Carolyn; Kapur, Nav; Webb, Roger T |
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| 組織名 | Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental;Health, University of Manchester, UK. Electronic address:;matthew.carr@manchester.ac.uk.;Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School,;University of Manchester, UK; NIHR Greater Manchester Primary Care Patient Safety;Translational Research Centre, UK.;Centre for Health Informatics, Institute of Population Health, University of;Manchester, UK; NIHR School for Primary Care Research, University of Manchester,;UK.;Health, University of Manchester, UK.;School of Psychological Sciences, University of Manchester, UK.;Research Institute of Primary Care and Health Sciences, Keele University, UK.;Health, University of Manchester, UK; Manchester Mental Health and Social Care;Trust, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/26994436/ |
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