使用初级保健电子健康记录识别双相情感障碍的先前信号:一个嵌套的病例控制研究
Catharine Morgan1, Darren M Ashcroft2, Carolyn A Chew-Graham3
1Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration, NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
概括
双相情感障碍 (BD) 的延迟诊断是常见的. 电子健康记录揭示了诸如精神病诊断,自我伤害和睡眠问题等在BD诊断前几年的模式,有助于早期检测.
科学领域:
- 精神病学是一个精神病学.
- 心理健康研究 心理健康研究
- 医疗信息学 医疗信息学
背景情况:
- 双极性障碍 (BD) 的诊断和治疗往往延迟了大约六年.
- 早期识别未诊断的BD对于及时干预和改善患者结果至关重要.
研究的目的:
- 用例行收集的电子健康记录来识别未被诊断的双相情感障碍 (BD) 的潜在信号.
- 在初级保健机构中建立BD早期检测的预测标记.
主要方法:
- 一项嵌套病例控制研究使用了英国临床实践研究数据链接 (CPRD) GOLD数据集.
- 成年患有偶发性双相情感障碍诊断 (病例) 的患者与没有诊断的双相情感障碍的对照进行了匹配.
- 条件后勤回归分析了BD诊断日期之前的健康事件和服务使用模式.
主要成果:
- 与对照组 (n=47138) 相比,发生双极性障碍的患者 (n=2366) 患有更高的抑郁症,精神病,焦虑症和人格障碍,以及自我伤害的升级率.
- 诊断前的信号包括睡眠障碍增加,物质滥用,情绪波动,频繁的咨询,错过预约和多药 (≥3类精神药物).
- 在正式诊断双相情感障碍之前,这些模式可以观察到长达10年的时间.
结论:
- 特定的精神病诊断,精神药物治疗模式和医疗保健利用可能表明未被诊断的双相情感障碍.
- 识别这些信号可以促使进一步调查,导致更早的诊断和治疗开始.
- 改善双相情感障碍的早期检测可以显著提高患者的管理和结果.
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