PREVALENCE OF PHYSICAL ILLNESS AMONG PSYCHIATRIC-INPATIENTS WHO DIE OF NATURAL CAUSES

Objective: The state psychiatric hospital is experiencing an increase in medically sick and aging patients who die of natural causes while h ospitalized. This study explored the ''medicalization'' of the state h ospital by examining the prevalence of medical illness and its relatio nship with psychiatric illness and age among state hospital psychiatri c inpatients who died of natural causes-deaths that were not accidents , homicides, or suicides. Methods: A total of 179 inpatients who died of natural causes at Western State Hospital in Washington State betwee n 1989 and 1994 were studied retrospectively through case file review. Their demographic and institutional characteristics and psychiatric d iagnoses were compared with those of others treated at the hospital (N =9,258), The medical diagnoses of patients who died were analyzed by a ge and psychiatric condition. Results: The patients who died were much older than the other patients treated during the study period, Two-th irds of those who died had organic mental disorders, mostly dementia, whereas only a fifth of the other patients had these disorders, The pa tients who died had a mean of eight physical illnesses, with a range f rom none to 21, Circulatory and respiratory conditions were most preva lent, affecting half to two-thirds of patients; these conditions had h igh rates of comorbidity with organic mental disorders. Conclusions: T he characteristics of the state hospital population and the services p rovided are shifting in response to mental health reform and new polic ies on patient self-determination, Increased emphasis on medical care added to traditional psychiatric services will require increased finan cial and personnel resources.