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ObjectivesAnxiety is a common condition usually managed in general practice (GP) in the UK. GP patient records can be used for epidemiological studies of anxiety as well as clinical audit and service planning. However, it is not clear how general practitioners (GPs) conceptualise, diagnose and document anxiety in these records. We sought to understand these factors through an interview study with GPs.SettingUK National Health Service (NHS) General Practice (England and Wales).Participants17 UK GPs.Primary and secondary outcome measuresSemistructured interviews used vignettes to explore the process of diagnosing anxiety in primary care and investigate influences on recording. Interviews were transcribed verbatim and analysed using thematic analysis.ResultsGPs chose 12 different codes for recording anxiety in the 2 vignettes, and reported that history, symptoms and management would be recorded in free text. GPs reported on 4 themes representing influences on recording of anxiety: ‘anxiety or a normal response’, ‘granularity of diagnosis’, ‘giving patients a label’ and ‘time as a tool’; and 3 themes about recording in general: ‘justifying the choice of code’, ‘usefulness of coding’ and ‘practice-specific pressures’. GPs reported using only a regular selection of codes in patient records to help standardise records within the practice and as a time-saving measure.ConclusionsWe have identified a coding culture where GPs feel confident recognising anxiety symptoms; however, due to clinical uncertainty, a long-term perspective and a focus on management, they are reluctant to code firm diagnoses in the initial stages. Researchers using GP patient records should be aware that GPs may prefer free text, symptom codes and other general codes rather than firm diagnostic codes for anxiety.

Background: Interoception, the sensing of information about the internal physiological state of the body, is proposed to be fundamental to normal and abnormal affective feelings. We undertook a cross-sectional characterisation of cardiac interoception in patients accessing secondary mental health services to understand how interoceptive abnormalities relate to psychiatric symptoms and diagnoses. Methods: Patients attending adult mental health services (205 female, 101 male) and controls (42 female, 21 male) participated. Clinical diagnoses spanned affective disorders, personality disorders and psychoses. Physiological, bio-behavioural and subjective interoceptive measures included: 1) Basal heart rate and heart rate variability (HRV); 2) cardiac afferent effects on emotional processing (cardiac cycle modulation of ratings of fear vs. neutral faces); 3) perceptual accuracy, confidence, and metacognitive insight in heartbeat detection, and; 4) self-reported sensitivity to internal bodily sensations. We tested for transdiagnostic differences between patients and controls, then for correlations between interoceptive measures and affective symptoms, and for group differences across clinical diagnostic categories. Results: Patients differed from controls in HRV, cardiac afferent effects on emotional processing, heartbeat discrimination accuracy, and heartbeat detection confidence. Anxiety and depression symptom severity correlated particularly with self-reported sensitivity to interoceptive experiences. Significant differences between diagnostic categories were observed for HRV, cardiac afferent effects on emotional processing, and subjective interoception. Patients with schizophrenia relative to other diagnoses intriguingly showed opposite cardiac afferent effects on emotion processing. Conclusions: This multilevel characterisation identified interoceptive differences associated with psychiatric symptoms and diagnoses. Interoceptive mechanisms have potential value for the clinical stratification and therapeutic targeting of psychiatric disorders.

Postnatal post-traumatic stress disorder (PTSD) affects 3%-4% of women who give birth. It is underdiagnosed and undertreated. Thus far, no studies have investigated doctors' perceptions of PTSD in postnatal women. We investigated whether GPs and psychiatrists perceive PTSD symptoms after birth to indicate pathology and what diagnosis and management they would offer. Semi-structured interviews were conducted with six GPs and seven psychiatrists using a fictional vignette featuring a woman experiencing PTSD following a traumatic birth. A framework analysis approach was used. Despite half the GPs recognizing trauma-related features in the vignette their most common diagnosis was postnatal depression whereas six of the seven psychiatrists identified PTSD. Management plans reflected this. Both GPs and psychiatrists lacked trust in timeliness of referrals to psychological services. Both suggested referral to specialist perinatal mental health teams. Results suggest women are unlikely to get a PTSD diagnosis during initial GP consultations, however the woman-centred care proposed by GPs means that a trauma-focussed diagnosis later in the care pathway was not ruled out. Further research is needed to confirm these findings, which suggest that an evidence base around best management for women with postnatal PTSD is sorely needed, especially to inform GP training. K E Y W O R D Sperinatal mental health, postnatal post-traumatic stress disorder, recognition of posttraumatic stress disorder | INTRODUCTIONChildbirth is a common life event perceived generally by society as a positive time in women's lives. From a physical health perspective giving birth has never been safer (Knight et al., 2017; World Health Organization, 2019). However approximately a third of women describe their experience of childbirth as psychologically traumatic