MORTALITY AND MEDICAL COMORBIDITY AMONG PSYCHIATRIC-PATIENTS - A REVIEW

Objectives: To fuel advocacy for improved health care for mentally ill persons, the authors reviewed the literature that describes excess mo rtality and underrecognition and undertreatment of comorbid medical co nditions in this population. Barriers to optimal primary medical care for psychiatric patients are discussed. Methods: A MEDLINE search focu sing on mortality rind medical problems in psychiatric patients yielde d 66 papers in English published between 1934 and 1996. These studies and a German paper from 1912 are included in the review. Results and C onclusions: Standardized mortality ratios for psychiatric patients, de rived from comparisons with the general population and matched control groups, have repeatedly demonstrated excess mortality from both natur al and unnatural causes among psychiatric patients. Several large stud ies that have attempted to clarify the issues underlying increased dea th rates are discussed. Although no single diagnostic group emerges as being at particularly high risk, substance abuse disorders alone or i n combination with other psychiatric disorders have been repeatedly fo und to lend to increased mortality rates. Other studies have also repe atedly demonstrated that psychiatric patients suffer a high rate of co morbid medical illnesses, which are largely undiagnosed and untreated and which may cause or exacerbate psychiatric symptoms. Atypical prese ntations are common, and changes in vision are the symptoms most predi ctive of medical illness. Elderly patients and those with diagnoses of organic brain syndromes are at highest risk for comorbid medical illn ess. Parity in the medical and mental health treatment of psychiatric patients requires both political advocacy and development of primary c are programs capable of efficiently meeting their needs.