Medical Evaluation of Psychiatric Patients

Koran, Lorrin M.; Sox, Harold C.; Marton, Keith I.; Moltzen, Sally; Sox, Carol H.; Kraemer, Helena C.; Imai, Kent; Kelsey, Thomas G.; Rose, Theodore G.; Levin, Larry C.; Chandra, Satish

doi:10.1001/archpsyc.1989.01810080063007

Cited by 236 publications

(35 citation statements)

References 19 publications

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“…Many studies (but not all) have found a high rate of medical and substance use problems among those with schizophrenia, but the evidence is not always compelling and the association between substance use and medical problems has not always been taken into account in the analyses. [15][16][17][18][19][20][21][22][23][24][25] When studying 'excess' treatment costs, the relationship between mental and medical illness is complex. In a study reporting higher medical care costs for adults with depression, Simon et al 26 suggested several possible reasons for this finding: (1) depression may increase patients' pain and distress, which in turn prompts them to seek help, (2) chronic medical conditions may interact with depression, increasing the need for both psychiatric and medical treatment, or, (3) increased attention from clinicians encourages return visits for treatment.…”

Section: Introductionmentioning

confidence: 99%

Schizophrenia, substance use disorders and medical co-morbidity

Dickey

Azeni

Weiss

et al. 2000

J. Mental Health Policy Econ.

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Objectives: This study compared medical treatment costs of adults with schizophrenia to adults with both substance use disorders and schizophrenia. Methods: This cross-sectional observational study used a paid claims data base to identify 6884 adults treated for schizophrenia. Twenty percent of these also had substance use disorder. We report the costs and likelihood of hospitalization for eight common medical diseases, and the categories of injuries and poisoning, and ill defined conditions. Multivariate analyses were used to adjust rates of treatment for age and sex differences in the comparison groups. Results: There were higher rates of treatment for five of the eight medical disorders, higher treatment costs for two of the medical disorders and much higher costs for psychiatric treatment among those with comorbid substance use disorders. Both groups had high rates of treatment in the categories of injury and poisoning and ill defined conditions. Conclusions: Closer working relationships among mental health and medical professionals are needed to care for those with schizophrenia and substance use disorders: first, greater attention to the treatment of substance use disorders may improve the health status of those with schizophrenia, reduce their costly medical and psychiatric care and stabilize their psychiatric condition, and second, continuity of care among professionals may promote willingness to seek medical attention or alleviate misunderstandings when adults with schizophrenia present with medical problems.

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Section: Introductionmentioning

confidence: 99%

Schizophrenia, substance use disorders and medical co-morbidity

Dickey

Azeni

Weiss

et al. 2000

J. Mental Health Policy Econ.

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“…Given the rate of physical co-morbidity and undetected physical disorders in psychiatric patients, [3][4][5] as well organic conditions presenting as mental illness, missing a potentially treatable physical condition can have tragic consequences for a patient. A thorough physical examination is a cost-effective way of ruling out important disorders and ophthalmological examination in particular is considered important.…”

Section: Discussionmentioning

confidence: 99%

“…2 Koran et al reported that thorough medical evaluation of 529 patients revealed active, important physical disease in 200 of them, with previously undetected diseases in 12 per cent of patients. 3 Goldman repor ted that nearly 50 per cent of patients with schizophrenia have medical comorbidity, who are less likely to report symptoms spontaneously, not seek or adhere to treatment, and not receive adequate physical health care. 4 The main findings of a crosssectional sur vey of long-stay psychiatric patients in a high-security psychiatric hospital by Cormac et al were a mean increase in weight, and high rates of smoking and obesity, with 54 per cent of patients having one or more health problems.…”

mentioning

confidence: 99%

Audit of ophthalmological examination in psychiatry

Kannabiran¹,

Singh²,

Narayan³

2007

Prog Neurol Psychiatry

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“…In addition, Koran et al (9), in a well-designed study of preva-lence of physical illness in a public mental health system, found that almost half of the patients had an important physical health diagnosis. Both studies stressed the need for psychiatrists to be more attentive to medical abnormalities in the emergency room and to document medical clearance evaluations (8,9).…”

Section: Discussionmentioning

confidence: 99%

The evaluation of homicidal patients by psychiatric residents in the emergency room: A pilot study

Jh²,

Mc³

et al. 1991

Psych Quart

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The authors report the results of a preliminary prospective study involving 110 patients who were involuntarily committed from the emergency room. The study was designed to clarify the process of how psychiatric residents evaluate homicidal patients. Eighteen patients (16%) were committed for homicidal ideation, of whom 89% were psychotic. Surprisingly, for patients committed because of a risk of homicide, vital signs were obtained for only 11%, during a mean evaluation time of 2.5 hours. Aspects of an appropriate physical examination and laboratory studies that enable the clinician to distinguish organic from functional illness are described. The authors conclude that patients with homicidal ideation may receive inadequate assessment prior to their involuntary commitment. Possible explanations and solutions for this, and recommendations for further studies are offered.

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Medical Evaluation of Psychiatric Patients

Cited by 236 publications

References 19 publications

Schizophrenia, substance use disorders and medical co-morbidity

Schizophrenia, substance use disorders and medical co-morbidity

Audit of ophthalmological examination in psychiatry

The evaluation of homicidal patients by psychiatric residents in the emergency room: A pilot study

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