Unrecognized medical emergencies admitted to psychiatric units

Alteration of mental status secondary to medical illness may occasionally b e incorrectly attributed to a psychiatric problem. The cases of 64 patients with unrecognized medical emergencies inappropriately admit ted to psychia tric units from emergency departments were reviewed to determine the cause of the misdiagnoses. Medical diagnoses most often missed included severe in toxication with alcohol or other illicit sub stance (34.4%), drug or alcoho l withdrawal or delirium tremens (12.5%), and prescription drug overdose (1 2.5%). In none of the cases (0%) was an appropriate mental status examinati on performed. Other common causes of misdiagnosis included inadequate physi cal examination (43.8%), failure to obtain indicated laboratory studies (34 .4%), and failure to obtain available history (34.4%). A systematic approac h is required for patients with altered mental status, including those with psychiatric presentations.