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Article   |    
Diagnosis of Physical Illness in Psychiatric Patients Using Axis III and a Standardized Medical History
Ann D'Ercole; Andrew E. Skodol; Elmer Struening; James Curtis; Joel Millman
Psychiatric Services 1991; doi:
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Manhattan Bowery corporation in New York City

Department of psychiatry at Columbia University College of Physicians and Surgeons; Department of social psychiatry at New York State Psychiatric Institute

Mental disorders research department at New York State Psychiatric Institute; Columbia University School of Public Health

Department of psychiatry at Harlem Hospital Center; Columbia University College of Physicians and Surgeons

Department of psychiatry at Harlem Hospital Center

© 1991 by the American Psychiatric Association

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Abstract

Psychiatrists' axis III diagnoses of physical illnesses in 357 psychiatric patients were compared with diagnoses by a physician's assistant using a standardized medical history form. The physician's assistant detected nearly three times as many physical illnesses as the psychiatrists. The psychiatrists were significantly more likely to miss diagnoses among older patients and women. Patients who met criteria for depressive disorders appeared to be at greatest risk for undetected illnesses, followed by patients with bipolar disorders and schizophrenia. Patients with a secondary diagnosis of substance abuse had significantly more undetected illness than those who did not abuse substances. The authors suggest that current axis III guidelines are inadequate and that a systematic review of physical health problems should be part of the psychiatric diagnostic assessment.

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