Impact of Co-Morbid Mental Illness on the Diagnosis and Management of Patients Hospitalized for Medical Conditions in a General Hospital

Abstract

Aims: Comorbidities including hyperglycemia, diabetes, and hypertension are frequently observed in psychiatric patients. Nevertheless, this population has higher rates of morbidity and mortality from medical illnesses compared to non-psychiatric patients. The present study evaluated the diagnosis and management of general medical hospitalized patients with and without mental illness. Methods: The study group consisted of 200 hospitalized subjects including 100 subjects who met the DSM-IV criteria for schizophrenia or bipolar disorder and 100 age-matched controls. All patients were evaluated for a comorbid condition, concomitant medication, biochemical parameters. Comorbid conditions were defined using the National Cholesterol Education Program risk factors categories: diabetes (fasting plasma glucose level ⩾ 126 mg/dl and/or pharmacological treatment); hypertension (systolic blood pressure ⩾ 140 mm Hg and/or diastolic BP ⩾ 90 mm Hg and/or pharmacological treatment); dyslipidemia (hypertriglyceridemia (⩾ 150 mg/dl); and/or pharmacological treatment and/or low HDL cholesterol level (< 40 mg/dl in men and < 50 mg/dl in women). Results: The two groups were similar in terms of age, sex, mean blood pressure, glucose, and lipids. Patients with a history of psychiatric illness were less frequently diagnosed with medical conditions such as hypertension, dyslipidemia, and diabetes compared to the non-psychiatric population, though according NCEP criteria, these conditions did not significantly differ between the two groups. Significantly fewer psychiatric than non-psychiatric patients received aspirin, statins, anti-hypertensive and anti-diabetic medications. Although more obesity was diagnosed in psychiatric patients, significantly fewer diet consults were performed during hospitalization. While significantly more smokers and more pulmonary hospitalizations were observed in the psychiatric group, fewer subjects in this group received instruction for smoking cessation compared to the non-psychiatric population. Conclusions: Comorbid medical conditions such as diabetes, hypertension, dyslipidemia, and obesity are under-diagnosed and under-treated in hospitalized psychiatric patients compared with the non-psychiatric population. Patients with mental illness have significantly less preventive intervention during hospitalization.