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      Comparing psychotropic medication prescribing in personality disorder between general mental health and psychological services: retrospective cohort study

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          Abstract

          Background

          Although no drugs are licensed for the treatment of personality disorder, pharmacological treatment in clinical practice remains common.

          Aims

          This study aimed to estimate the prevalence of psychotropic drug use and associations with psychological service use among people with personality disorder.

          Method

          Using data from a large, anonymised mental healthcare database, we identified all adult patients with a diagnosis of personality disorder and ascertained psychotropic medication use between 1 August 2015 and 1 February 2016. Multivariable logistic regression models were constructed, adjusting for sociodemographic, clinical and service use factors, to examine the association between psychological services use and psychotropic medication prescribing.

          Results

          Of 3366 identified patients, 2029 (60.3%) were prescribed some form of psychotropic medication. Patients using psychological services were significantly less likely to be prescribed psychotropic medication (adjusted odds ratio 0.48, 95% CI 0.39–0.59, P<0.001) such as antipsychotics, benzodiazepines and antidepressants. This effect was maintained following several sensitivity analyses. We found no difference in the risk for mood stabiliser (adjusted odds ratio 0.79, 95% CI 0.57–1.10, P = 0.169) and multi-class psychotropic use (adjusted odds ratio 0.80, 95% CI 0.60–1.07, P = 0.133) between patients who did and did not use psychological services.

          Conclusions

          Psychotropic medication prescribing is common in patients with personality disorder, but significantly less likely in those who have used psychological services. This does not appear to be explained by differences in demographic, clinical and service use characteristics. There is a need to develop clear prescribing guidelines and conduct research in clinical settings to examine medication effectiveness for this population.

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          Most cited references23

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          Health of the Nation Outcome Scales (HoNOS). Research and development.

          An instrument was required to quantify and thus potentially measure progress towards a Health of the Nation target, set by the Department of Health, "to improve significantly the health and social functioning of mentally ill people". A first draft was created in consultation with experts and on the basis of literature review. This version was improved during four stages of testing: two preliminary stages, a large field trial involving 2706 patients (rated by 492 clinicians) and tests of the final Health of the Nation Outcome Scales (HoNOS), which included an independent study (n = 197) of reliability and relationship to other instruments. The resulting 12-item instrument is simple to use, covers clinical problems and social functioning with reasonable adequacy, has been generally acceptable to clinicians who have used it, is sensitive to change or the lack of it, showed good reliability in independent trials and compared reasonably well with equivalent items in the Brief Psychiatric Rating Scales and Role Functioning Scales. The key test for HoNOS is that clinicians should want to use it for their own purposes. In general, it has passed that test. A further possibility, that HoNOS data collected routinely as part of a minimum data set, for example for the Care Programme Approach, could also be useful in anonymized and aggregated form for public health purposes, is therefore testable but has not yet been tested.
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            Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource

            Purpose The South London and Maudsley National Health Service (NHS) Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register and its Clinical Record Interactive Search (CRIS) application were developed in 2008, generating a research repository of real-time, anonymised, structured and open-text data derived from the electronic health record system used by SLaM, a large mental healthcare provider in southeast London. In this paper, we update this register's descriptive data, and describe the substantial expansion and extension of the data resource since its original development. Participants Descriptive data were generated from the SLaM BRC Case Register on 31 December 2014. Currently, there are over 250 000 patient records accessed through CRIS. Findings to date Since 2008, the most significant developments in the SLaM BRC Case Register have been the introduction of natural language processing to extract structured data from open-text fields, linkages to external sources of data, and the addition of a parallel relational database (Structured Query Language) output. Natural language processing applications to date have brought in new and hitherto inaccessible data on cognitive function, education, social care receipt, smoking, diagnostic statements and pharmacotherapy. In addition, through external data linkages, large volumes of supplementary information have been accessed on mortality, hospital attendances and cancer registrations. Future plans Coupled with robust data security and governance structures, electronic health records provide potentially transformative information on mental disorders and outcomes in routine clinical care. The SLaM BRC Case Register continues to grow as a database, with approximately 20 000 new cases added each year, in addition to extension of follow-up for existing cases. Data linkages and natural language processing present important opportunities to enhance this type of research resource further, achieving both volume and depth of data. However, research projects still need to be carefully tailored, so that they take into account the nature and quality of the source information.
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              The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data

              Background Case registers have been used extensively in mental health research. Recent developments in electronic medical records, and in computer software to search and analyse these in anonymised format, have the potential to revolutionise this research tool. Methods We describe the development of the South London and Maudsley NHS Foundation Trust (SLAM) Biomedical Research Centre (BRC) Case Register Interactive Search tool (CRIS) which allows research-accessible datasets to be derived from SLAM, the largest provider of secondary mental healthcare in Europe. All clinical data, including free text, are available for analysis in the form of anonymised datasets. Development involved both the building of the system and setting in place the necessary security (with both functional and procedural elements). Results Descriptive data are presented for the Register database as of October 2008. The database at that point included 122,440 cases, 35,396 of whom were receiving active case management under the Care Programme Approach. In terms of gender and ethnicity, the database was reasonably representative of the source population. The most common assigned primary diagnoses were within the ICD mood disorders (n = 12,756) category followed by schizophrenia and related disorders (8158), substance misuse (7749), neuroses (7105) and organic disorders (6414). Conclusion The SLAM BRC Case Register represents a 'new generation' of this research design, built on a long-running system of fully electronic clinical records and allowing in-depth secondary analysis of both numerical, string and free text data, whilst preserving anonymity through technical and procedural safeguards.
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                Author and article information

                Journal
                BJPsych Open
                BJPsych Open
                BJO
                BJPsych Open
                Cambridge University Press (Cambridge, UK )
                2056-4724
                March 2021
                25 March 2021
                : 7
                : 2
                : e72
                Affiliations
                [1]Institute of Psychiatry, Psychology and Neuroscience, King's College London , UK
                [2]Croydon Personality Disorder Service, South London and Maudsley NHS Foundation Trust , UK
                [3]Croydon Personality Disorder Service, South London and Maudsley NHS Foundation Trust , UK
                [4]Institute of Psychiatry, Psychology and Neuroscience, King's College London , UK; Global Health Program, College of Public Health, National Taiwan University , Taiwan; and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University , Taiwan
                [5]Institute of Psychiatry, Psychology and Neuroscience, King's College London , UK; and Waterview Centre, Central and North West London NHS Foundation Trust , UK
                [6]Institute of Psychiatry, Psychology and Neuroscience, King's College London , UK
                [7]Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol , UK
                [8]BRC Nucleus, South London and Maudsley NHS Foundation Trust , UK
                [9]Institute of Psychiatry, Psychology and Neuroscience, King's College London , UK
                [10]Institute of Psychiatry, Psychology and Neuroscience, King's College London , UK; and BRC Nucleus, South London and Maudsley NHS Foundation Trust , UK
                Author notes
                Correspondence: Giouliana Kadra-Scalzo. Email: giouliana.kadra@ 123456kcl.ac.uk
                [*]

                Joint first authors.

                Author information
                https://orcid.org/0000-0003-3182-905X
                https://orcid.org/0000-0002-6432-4392
                https://orcid.org/0000-0003-2291-6952
                https://orcid.org/0000-0002-4435-6397
                Article
                S205647242100034X
                10.1192/bjo.2021.34
                8058890
                33762065
                c68eee81-020e-4329-b534-bfaed4233bb6
                © The Author(s) 2021

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 December 2020
                : 08 February 2021
                : 25 February 2021
                Page count
                Tables: 4, References: 24, Pages: 6
                Categories
                Academic Psychiatry
                Papers

                personality disorder,psychological services,general mental health,medication prescribing,psychotropics

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