Treatment in combined medical psychiatry units: an integrative model.

Approximately 14 medical psychiatry units have opened over the last 15 years due to the recognition of the frequent concurrence of medical and psychiatric illnesses. This article discusses the clinical problems encountered when medical care and psychiatric care are integrated and their impact on medical and nursing staff. Group therapy programs on medical psychiatry units may enhance psychiatric treatment and help maintain a psychiatric focus by both patients and staff, despite the patients' significant medical problems.

Unrecognized physical illness prompting psychiatric admission: a prospective study.

The authors studied 100 state hospital psychiatric patients consecutively admitted to a research ward who were screened to eliminate physical illness before admission. They found an unusually high incidence of medical illness: 46% of these patients had an unrecognized medical illness that either caused or exacerbated their psychiatric illness, 80% had physical illnesses requiring treatment, and 4% had precancerous conditions or illnesses. A workup consisting of psychiatric and physical examination, SMA-34, urinalysis, ECG, and EEG after sleep deprivation identified over 90% of medical illnesses present in this population.

Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population.

One hundred patients of lower socioeconomic class were intensively evaluated medically on a research ward for the presence of unrecognized medical illnesses that might have affected their hospitalization. Forty-six percent were thought to have medical illnesses that directly caused or greatly exacerbated their symptoms and were consequently responsible for their admission, while an additional 34% of patients were found to be suffering from a medical illness requiring treatment. A diagnostic battery of physical, psychiatric, and neurologic examinations, coupled with a 34-panel automated blood analysis, complete blood cell count, urinanalysis, ECG, and sleep-deprived EEG established the presence and nature of more than 90% of the illnesses detected, and is therefore recommended as an initial evaluation battery, particularly for patients facing involuntary commitment to a mental hospital.