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PS 1996; 47:1356-1363
Copyright © 1996 by American Psychiatric Association
Mortality and medical comorbidity among psychiatric patients: a review
B Felker, JJ Yazel and D Short
University of Washington School of Medicine, Seattle, USA.
OBJECTIVES: To fuel advocacy for improved health care for mentally ill
persons, the authors reviewed the literature that describes excess
mortality and underrecognition and undertreatment of comorbid medical
conditions in this population. Barriers to optimal primary medical care for
psychiatric patients are discussed. METHODS: A MEDLINE search focusing on
mortality and medical problems in psychiatric patients yielded 66 papers in
English published between 1934 and 1996. These studies and a German paper
from 1912 are included in the review. RESULTS AND CONCLUSIONS: Standardized
mortality ratios for psychiatric patients, derived from comparisons with
the general population and matched control groups, have repeatedly
demonstrated excess mortality from both natural and unnatural causes among
psychiatric patients. Several large studies that have attempted to clarify
the issues underlying increased death rates are discussed. Although no
single diagnostic group emerges as being at particularly high risk,
substance abuse disorders alone or in combination with other psychiatric
disorders have been repeatedly found to lead to increased mortality rates.
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. Atypical presentations are common, and changes in vision are the
symptoms most predictive of medical illness. Elderly patients and those
with diagnoses of organic brain syndromes are at highest risk for comorbid
medical illness. Parity in the medical and mental health treatment of
psychiatric patients requires both political advocacy and development of
primary care programs capable of efficiently meeting their needs.
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