User:Anthonyhcole/Differential

The authors reviewed 21 studies dealing with the rate of diagnosed and undiagnosed physical illnesses in the psychiatric patient population. These studies performed by different authors in variable clinical settings with diverse methodology in different locations over a period of 45 years yielded a close concordance. Approximately half of the patients (50.1%) suffered from significant physical illnesses, of these 58.2% were previously undiagnosed. A substantial portion of the physical illnesses (27.1%) produced symptoms showing direct relation to the psychopathology of the patient. These numbers are quite close to those found by authors in earlier research.
 * Koranyi, E. K.; Potoczny, W. M. (1992). "Physical Illnesses Underlying Psychiatric Symptoms". Psychotherapy and Psychosomatics 58 (3-4): 155. doi:10.1159/000288623..

Other studies have also repeatedly demonstrated that psychiatric patients suffer a high rate of comorbid medical illnesses, which are largely undiagnosed and untreated and which may cause or exacerbate psychiatric symptoms.

Fourteen percent of the patients had diseases known to themselves but not to the mental health system, and 12% of the patients had diseases newly detected by the study team. We estimate that of the more than 300,000 patients treated in the California public mental health system in fiscal year 1983 to 1984, 45% had an active, important physical disease. The mental health system had recognized only 47% of study patients' physical diseases, including 32 of 38 diseases causing a mental disorder and 23 of 51 diseases exacerbating a mental disorder. Patients treated in public sector mental health facilities should receive careful medical evaluations.

In 215 patients referred to a specialized medical-psychiatric inpatient unit, thorough neuropsychiatric evaluation resulted in a therapeutically important alteration of the referring diagnosis in 41%. Of patients referred with a tentative diagnosis of dementia, 63% were found to have treatable conditions.

A careful physical and laboratory evaluation of 144 chronic psychiatric outpatients revealed medical illnesses in 26%. Chart review indicated that 13% of the patients had illnesses that were previously undetected and that 13% of the patients received some form of new treatment because of the evaluation. The majority of the illnesses did not appear to have directly caused or exacerbated psychiatric symptoms. Because medical illnesses were relatively common in this population, psychiatrists caring for chronic psychiatric outpatients often need to assume some of the health care referral and coordinating functions typically associated with a primary care physician.

We report a study of 102 consecutive admissions to the acute medical care unit of a large psychiatric hospital. The study was designed to investigate the epidemiology and the barriers to diagnosis and treatment of medical illness among female psychiatric inpatients. The majority of the patients were transferred to the unit because of nonspecific changes in physical condition or for behavioral differences. More than 70% of the patients were unable to communicate adequately with the physician. Ninety-two percent of the sample were found to have at least one with an average of three previously undiagnosed physical diseases not predicted by their symptoms on referral. We advocate a high index of suspicion of physical disease in the psychiatric population, and recommend an aggressive multidisciplinary diagnostic and therapeutic approach.

The prevalence and significance of medical illnesses were examined in a sample of chronically mentally ill patients from an urban community mental health program. Eighty-eight percent had at least one significant medical illness, 51% had at least one previously undiagnosed illness and 53% were judged to be in need of some form of medical attention. The bulk of these illnesses were typical of primary care problems. In terms of causal significance, nearly as many medical illnesses appeared to be the result of the psychiatric disorder (18%) as vice versa (22%). Community mental health programs should make provisions for the medical needs of patients in comprehensive management programs.

The 50 subjects represent 14 men and 36 women who met RCD criteria for depression (major, minor, and intermittent). Depression tended to be recurrent and to be quite lengthy. Thirty-eight were taking at least one medication, 19 of which could have been depressogenic. Forty-four had at least one medical diagnosis or problem determined by the history or the laboratory data. It was determined that depression was associated with a medical illness in 22, with a medication in four, and with both an illness and medication in seven. Thus, out of the 50, 52% were having depressions definitely or probably associated with a medical illness or medicine. Medical illness and medication use are commonly present in the elderly population, are often unrecognized, and can contribute to depression.

Awareness of the medical disorders that frequently present with neuropsychiatric signs and symptoms and careful attention to a basic medical evaluation in every "psychiatric" patient will obviate referral of such patients to mental health facilities where their medical problems are less likely to be property diagnosed and treated. These disorders can be organized according to the predominant area of psychopathology (delirium, dementia, organic amnestic, delusional, hallucinatory, affective, and personality syndromes).:

__NOINDEX__ Widespread use of extensive screening batteries, consisting of complete blood cell count (CBC), complete blood chemistry analysis, erythrocyte sedimentation rate (ESR), urinalysis, B12, folate, electroencephalogram (EEG), electrocardiogram (EKG), and chest x-ray film, is not indicated in the majority of psychiatric patients [...] Certain populations appear to benefit from more extensive evaluation, including those older than 65 years of age or of low socioeconomic status, state hospital patients, patients with drug and alcohol histories, and patients with evidence of disorientation, self neglect, or organic mental disorders.

We examined the clinical utility of routine admission laboratory testing for medical disorders in 250 psychiatric inpatients by using clinical criteria to classify laboratory abnormalities as true- or false-positive results. The mean number of tests per patient was 27.7. The mean percentage of true-positive results was 1.8%; the mean predictive value was 12%. When three clinically defined subgroups were examined, both measures of test performance varied in direct proportion to the pretest probability of medical disease. Eleven patients (4%) had important medical problems discovered through routine laboratory testing. A testing battery consisting of nine tests in women and 13 in men would have identified all of these patients. Our results suggest that extensive, routine testing for medical disorders in this setting is unnecessary and that more efficient and accurate testing strategies, based on clinical information, can and should be developed.

Undetected physical illnesses causing or exacerbating psychopathology in psychiatric patients have been reported by many. Definitive answers regarding the extent of this problem are not available as the current findings are tainted with methodological problems. A number of patient-related and physician-related problems make it difficult to conduct a good physical examination of psychiatric patients. However, it is important that a good physical examination is conducted prior to initiating psychiatric treatment. Physical illness should be suspected in psychiatric patients with atypical presentation and atypical response. A high degree of suspicion and investigations pertinent to the patients condition are more useful than any standard screening procedure.

Of 524 new patients for whom psychiatric consultation was requested during a one-year period at two Milwaukee hospital centers, 99 (19%) had CT scans of the brain. In 25 of these, the scan played a major role in clarifying the diagnosis.

It appears that relationships could be demonstrated between experience of distress and presentation of psychological symptoms during consultations, on the one hand, and common physical disorders, on the other. Patients with neurological diseases (Parkinson's, epilepsy, multiple sclerosis) and gastric ulcers showed the same relationships, but were also more frequently diagnosed by the GP as having psychological disorders.

Underdiagnosis of medical illness in psychiatric patients remains a serious problem in health care. Several resent controlled studies have indicated that endocrine disorders in general, and thyroid diseases in particular, are the most frequent medical conditions causing or exacerbating behavioral symptomatology.