Early signs of bipolar disorder in a UK primary care patient cohort

Morgan, Catharine; Ashcroft, Darren M.; Webb, Roger T.; Chew-Graham, Carolyn A.; Francis, Anya; Yung, Alison R.

Abstract

Background: Bipolar Disorder (BD) is a serious mental illness characterized by mood instability. Delay in diagnosis is typically between 6–10 years with many experiencing persistent untreated symptoms and potentially poorer outcomes such as poor social adjustment and high prevalence of coexisting cardiovascular, endocrine/metabolic or neurological conditions. There is no agreed strategy for improving early identification and treatment of BD.

Objectives: To identify signs of emerging Bipolar Disorder, including prior mental illness symptomatology and diagnoses, psychotropic medication prescribing and health service engagement.

Methods: The Clinical Practice Research Datalink (CPRD) is an anonymised primary care electronic patient record database with linkage to secondary data. Adult incident BD diagnoses made during years 2010–2017 inclusive were extracted using Read and ICD-10 codes. Matching by age, gender and GP practice was applied using 1:20 ratio of case:comparators without BD. Extracted health events prior to index date included other mental illness diagnoses, prescriptions (antidepressants, antipsychotics, benzodiazepines, Z-drugs, mood stabilizers, pregabalin, gabapentin, strong opioids), substance abuse, self-harm/suicidal ideation, mood swings, sleep disturbance and service interactions (face-to-face consultations, missed appointments, A&E presentations, referral to mental health services). Annual episode incidence for cases and comparators and odds ratios of cases presenting with each health event prior to index date were reported.

Results: There were 2,366 incident BD cases and 47,138 comparators (median age 40 years, 60.5% females). Cases had higher incidence of depression, schizophrenia, personality and anxiety disorders even 10 years before BD diagnosis compared to non BD comparators. Cases were 8 times more likely to have received 3 different categories of prescription 6 years prior to index date (OR: 8.4 [95% CI 6.8, 10.6]; p < 0.001). The number of face-to-face consultations was higher in all years prior to index date, with a median [IQR] of 8[15] for cases vs 4[9] for comparators, p < 0.001. At 5 years prior to BD diagnosis, cases were 5 times more likely to miss 6 scheduled appointments in a year compared to comparators.

Conclusions: Potentially useful signals to raise awareness in primary and specialist care include more than three psychiatric drug prescriptions during the same year, multiple GP attendances in one year, increasing frequency of non-attendance of scheduled appointments. Knowledge about these signs could aid earlier detection of the illness, leading to more timely and appropriate care.

Citation

Morgan, C., Ashcroft, D. M., Webb, R. T., Chew-Graham, C. A., Francis, A., & Yung, A. R. (2019, August). Early signs of bipolar disorder in a UK primary care patient cohort. Paper presented at 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Pennsylvania Convention Center, Philadelphia, PA, USA

• Presentation Conference Type: Conference Paper (unpublished)
• Conference Name: 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management
• Conference Location: Pennsylvania Convention Center, Philadelphia, PA, USA
• Start Date: Aug 24, 2019
• End Date: Aug 28, 2019
• Deposit Date: Jun 23, 2023