{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:15:33Z","timestamp":1787969733012,"version":"build-2784847793"},"reference-count":36,"publisher":"Royal College of General Practitioners","issue":"740","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"accepted":{"date-parts":[[2023,4,24]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Bipolar disorders are serious mental illnesses, yet evidence suggests that the diagnosis and treatment of bipolar disorder can be delayed by around 6 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To identify signals of undiagnosed bipolar disorder using routinely collected electronic health records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>A nested case\u2013control study conducted using the UK Clinical Practice Research Datalink (CPRD) GOLD dataset, an anonymised electronic primary care patient database linked with hospital records. \u2018Cases\u2019 were adult patients with incident bipolar disorder diagnoses between 1 January 2010 and 31 July 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The patients with bipolar disorder (the bipolar disorder group) were matched by age, sex, and registered general practice to 20 \u2018controls\u2019 without recorded bipolar disorder (the control group). Annual episode incidence rates were estimated and odds ratios from conditional logistic regression models were reported for recorded health events before the index (diagnosis) date.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 2366 patients with incident bipolar disorder diagnoses and 47 138 matched control patients (median age 40 years and 60.4% female:<jats:italic>n<\/jats:italic>= 1430\/2366 with bipolar disorder and<jats:italic>n<\/jats:italic>= 28 471\/47 138 without). Compared with the control group, the bipolar disorder group had a higher incidence of diagnosed depressive, psychotic, anxiety, and personality disorders and escalating self-harm up to 10 years before a bipolar disorder diagnosis. Sleep disturbance, substance misuse, and mood swings were more frequent among the bipolar disorder group than the control group. The bipolar disorder group had more frequent face-to-face consultations, and were more likely to miss multiple scheduled appointments and to be prescribed \u22653 different psychotropic medication classes in a given year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Psychiatric diagnoses, psychotropic prescriptions, and health service use patterns might be signals of unreported bipolar disorder. Recognising these signals could prompt further investigation for undiagnosed significant psychopathology, leading to timely referral, assessment, and initiation of appropriate treatments.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp.2022.0286","type":"journal-article","created":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T11:40:43Z","timestamp":1697024443000},"page":"e165-e173","source":"Crossref","is-referenced-by-count":6,"title":["Identifying prior signals of bipolar disorder using primary care electronic health records: a nested case\u2013control study"],"prefix":"10.3399","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9033-1986","authenticated-orcid":false,"given":"Catharine","family":"Morgan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2958-915X","authenticated-orcid":false,"given":"Darren M","family":"Ashcroft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9722-9981","authenticated-orcid":false,"given":"Carolyn A","family":"Chew-Graham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5351-9960","authenticated-orcid":false,"given":"Matthew","family":"Sperrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8532-2647","authenticated-orcid":false,"given":"Roger T","family":"Webb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1026-7265","authenticated-orcid":false,"given":"Anya","family":"Francis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7203-8601","authenticated-orcid":false,"given":"Jan","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0401-9791","authenticated-orcid":false,"given":"Alison R","family":"Yung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2023,10,11]]},"reference":[{"key":"2024082303500718000_74.740.e165.1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v64n0111"},{"key":"2024082303500718000_74.740.e165.2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.64.5.543"},{"key":"2024082303500718000_74.740.e165.3","doi-asserted-by":"publisher","DOI":"10.1177\/0706743716656607"},{"key":"2024082303500718000_74.740.e165.4","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.110.083840"},{"key":"2024082303500718000_74.740.e165.5","doi-asserted-by":"crossref","unstructured":"Hughes T Cardno A West R (2016) Unrecognised bipolar disorder among UK primary care patients prescribed antidepressants: an observational study. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp16X683437.","DOI":"10.3399\/bjgp16X683437"},{"key":"2024082303500718000_74.740.e165.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2013.09.008"},{"key":"2024082303500718000_74.740.e165.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2012.01917.x"},{"issue":"8","key":"2024082303500718000_74.740.e165.8","doi-asserted-by":"crossref","first-page":"e809","DOI":"10.4088\/JCP.13m08899","article-title":"Suicide, hospital-presenting suicide attempts, and criminality in bipolar disorder: examination of risk for multiple adverse outcomes","volume":"75","author":"Webb","year":"2014","journal-title":"J Clin Psychiatry"},{"issue":"5","key":"2024082303500718000_74.740.e165.9","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.psym.2012.10.011","article-title":"General medical conditions are associated with delay to treatment in patients with bipolar disorder","volume":"54","author":"Maina","year":"2013","journal-title":"Psychosomatics"},{"key":"2024082303500718000_74.740.e165.10","doi-asserted-by":"publisher","DOI":"10.1046\/j.1399-5618.2003.00067.x"},{"key":"2024082303500718000_74.740.e165.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2004.01.015"},{"key":"2024082303500718000_74.740.e165.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2005.05.011"},{"key":"2024082303500718000_74.740.e165.13","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.157.11.1873"},{"key":"2024082303500718000_74.740.e165.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.10.024"},{"issue":"5","key":"2024082303500718000_74.740.e165.15","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1159\/000362564","article-title":"Screening for bipolar disorder: confusion between case-finding and screening","volume":"83","author":"Zimmerman","year":"2014","journal-title":"Psychother Psychosom"},{"key":"2024082303500718000_74.740.e165.16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0126530"},{"key":"2024082303500718000_74.740.e165.17","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.126"},{"key":"2024082303500718000_74.740.e165.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(02)00100-3"},{"key":"2024082303500718000_74.740.e165.19","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291710001790"},{"key":"2024082303500718000_74.740.e165.20","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"2024082303500718000_74.740.e165.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2009.03.080"},{"key":"2024082303500718000_74.740.e165.22","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.60.7.709"},{"key":"2024082303500718000_74.740.e165.23","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jad.2020.02.035","article-title":"Psychiatric comorbidities in bipolar disorders: an examination of the prevalence and chronology of onset according to sex and bipolar subtype","volume":"267","author":"Loftus","year":"2020","journal-title":"J Affect Disord"},{"key":"2024082303500718000_74.740.e165.24","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2010.10030328"},{"issue":"10","key":"2024082303500718000_74.740.e165.25","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1176\/appi.ajp.2016.15101293","article-title":"The bi-directional associations between psychotic experiences and DSM-IV mental disorders","volume":"173","author":"McGrath","year":"2016","journal-title":"Am J Psychiatry"},{"key":"2024082303500718000_74.740.e165.26","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-012-0323-6"},{"key":"2024082303500718000_74.740.e165.27","doi-asserted-by":"crossref","first-page":"101429","DOI":"10.1016\/j.smrv.2021.101429","article-title":"Sleep disturbances and first onset of major mental disorders in adolescence and early adulthood: a systematic review and meta-analysis","volume":"57","author":"Scott","year":"2021","journal-title":"Sleep Med Rev"},{"key":"2024082303500718000_74.740.e165.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2014.06.006"},{"issue":"9","key":"2024082303500718000_74.740.e165.29","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.4088\/JCP.0906e10","article-title":"Update on bipolar disorder and substance abuse: recent findings and treatment strategies","volume":"67","author":"Ostacher","year":"2006","journal-title":"J Clin Psychiatry"},{"key":"2024082303500718000_74.740.e165.30","doi-asserted-by":"publisher","DOI":"10.1186\/1747-597X-2-29"},{"key":"2024082303500718000_74.740.e165.31","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-009-0085-2"},{"key":"2024082303500718000_74.740.e165.32","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2012.650"},{"issue":"1","key":"2024082303500718000_74.740.e165.33","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1093\/fampra\/cmy019","article-title":"Bipolar disorder in primary care: a qualitative study of clinician and patient experiences with diagnosis and treatment","volume":"36","author":"Cerimele","year":"2019","journal-title":"Fam Pract"},{"key":"2024082303500718000_74.740.e165.34","unstructured":"National Institute for Health and Care Excellence (2020) Bipolar disorder: assessment and management CG185 (NICE, London) https:\/\/www.nice.org.uk\/guidance\/cg185 (accessed 28 Nov 2023)."},{"key":"2024082303500718000_74.740.e165.35","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-7-117"},{"key":"2024082303500718000_74.740.e165.36","unstructured":"NHS England (2019) NHS Mental Health Implementation Plan 2019\/20\u20132023\/24, https:\/\/www.longtermplan.nhs.uk\/wp-content\/uploads\/2019\/07\/nhs-mental-health-implementation-plan-2019-20-2023-24.pdf (accessed 28 Nov 2023)."}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2022.0286","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T10:53:03Z","timestamp":1724410383000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2022.0286"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,11]]},"references-count":36,"journal-issue":{"issue":"740","published-online":{"date-parts":[[2024,2,29]]},"published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.3399\/BJGP.2022.0286"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2022.0286","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,11]]}}}