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August 1989

Medical Evaluation of Psychiatric PatientsI. Results in a State Mental Health System

Author Affiliations

From the Departments of Psychiatry and Behavioral Sciences (Drs Koran and Kraemer and Ms Moltzen) and Medicine (Drs H. C. Sox, Marton, and C. H. Sox), Stanford (Calif) Medical Center; the Department of Medicine, Santa Clara Valley Medical Center, San Jose, Calif (Drs Imai and Kelsey); the Department of Medicine, Natividad Medical Center, Salinas, Calif (Dr Rose); and Santa Cruz (Calif) Medical Clinic (Dr Levin). Dr Chandra is in private practice in Santa Cruz. Dr Rose is now with Highland General Hospital, Oakland, Calif; Dr Sox is now with the Department of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH; and Dr Marton is now with the Department of Medicine, Pacific Presbyterian Medical Center, San Francisco, Calif.

Arch Gen Psychiatry. 1989;46(8):733-740. doi:10.1001/archpsyc.1989.01810080063007

• Thorough medical evaluation of 529 patients drawn from eight program categories in California's public mental health system revealed active, important physical disease in 200 patients who had 291 diseases. Fourteen percent of the patients had diseases known to themselves but not to the mental health system, and 12% of the patients had diseases newly detected by the study team. We estimate that of the more than 300 000 patients treated in the California public mental health system in fiscal year 1983 to 1984, 45% had an active, important physical disease. The mental health system had recognized only 47% of study patients' physical diseases, including 32 of 38 diseases causing a mental disorder and 23 of 51 diseases exacerbating a mental disorder. Patients treated in public sector mental health facilities should receive careful medical evaluations.