Unrecognized physical illness prompting psychiatric admission.
BACKGROUND
We assessed factors that might contribute to clinicians erroneously attributing medically based changes in a patient's mental status to psychiatric illness.


METHODS
Records of 1340 patients admitted to a VA hospital psychiatric unit and 613 to a public hospital psychiatric unit from 2001 to 2007 were reviewed. Cases admitted because of an unrecognized medical disorder underwent further analysis of the preadmission assessment and documented history of mental illness.


RESULTS
Of 1340 patients whose records were reviewed, 55 (2.8%) had a medical disorder that caused their symptoms. Compared with patients admitted to medical units, patients inappropriately admitted to psychiatric units had lower rates of completion of medical histories, physical examinations, cognitive assessments, indicated laboratory and/or radiologic studies, and treatment of abnormal vital signs (P < .001 in each case). Among patients admitted to psychiatric units, 85.5% had a history of mental illness vs 30.9% of comparable admissions to medical units (Chi2(1) = 35.85; P < .001).


CONCLUSIONS
Key assessment procedures are less likely to be performed in patients with mental status changes who are admitted to psychiatric units than in comparable patients admitted to medical units. Symptoms of patients with a history of mental illness are more likely to be attributed to psychiatric illness than are those of patients without such a history.
Reeves
Roy R
RR
University of Mississippi School of Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS 39216 USA. roy.reeves@va.gov
Parker
Jefferson D
JD
Loveless
Peggy
P
Burke
Randy S
RS
Hart
Roy H
RH
D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D057210:Delayed Diagnosis; D003951:Diagnostic Errors / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008487:Medical History Taking; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008609:Mental Status Schedule; D008875:Middle Aged; D008922:Mississippi; D019965:Neurocognitive Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D010343:Patient Admission; D011567:Psychiatric Department, Hospital; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D055815:Young Adult