title: Where are patients who have co-occurring mental and physical diseases located?
abstract: BACKGROUND
  Patients with a psychiatric illness have a higher prevalence of physical diseases and thus a higher morbidity and mortality.
  
  
  OBJECTIVE
  The main aim was to investigate where patients with co-occurring physical diseases and mental disorders (psychotic spectrum or mood) in the health and social service system are identified most frequently before admission into psychiatry. The second aim was to compare the differences in the treatment routes taken by the patients before entry into psychiatric services in all the participating countries (Denmark, Germany, Japan, Nigeria and Switzerland).
  
  
  METHODS
  On admission to a psychiatric service, patients diagnosed with schizophrenia, schizotypal or delusional disorders (International Classification of Diseases-10 (ICD-10) group F2) or mood (affective) disorders (ICD-10 group F3) and a co-morbid physical condition (cardiovascular disease, diabetes mellitus and overweight) were asked with which institutions or persons they had been in contact with in the previous 6 months.
  
  
  RESULTS
  Patients from Denmark, Germany and Switzerland with mental disorders had almost the same contact pattern. Their primary contact was to public or private psychiatry, with a contact percentage of 46%-91%; in addition, general practice was a common contact, with a margin of 41%-93%. Similar tendencies are seen in Japan despite the small sample size. With regard to general practice, this is also the case with Nigerian patients. However, religious guidance or healing was rarely sought by patients in Europe and Japan, while in Nigeria about 80% of patients with mental disorders had contacted this type of service.
  
  
  CONCLUSIONS
  Promoting prophylactic work between psychiatry and the general practice sector may be beneficial in diminishing physical conditions such as cardiovascular disease, diabetes mellitus and overweight in patients with mental disorders in European countries and Japan. In Nigeria (a low-to-middle-income country), religious guides or healers, along with general practitioners, are the most frequently contacted, and they therefore seem to be the most obvious partner to collaborate with.
authors.affiliation: Department of Organic Psychiatric Disorder and Emergency Ward, Aarhus University Hospital, Risskov, Denmark.
authors.forename: Kristian L
authors.initials: KL
authors.lastname: Toftegaard
authors.affiliation: Department of Organic Psychiatric Disorder and Emergency Ward, Aarhus University Hospital, Risskov, Denmark.
authors.forename: Lea Nørgreen
authors.initials: LN
authors.lastname: Gustafsson
authors.affiliation: Faculty of Medicine, Nnamdi Azikiwe University, Nnewi, Nigeria.
authors.forename: Richard
authors.initials: R
authors.lastname: Uwakwe
authors.affiliation: Odense University Hospital, Odense, Denmark.
authors.forename: Ulla A
authors.initials: UA
authors.lastname: Andersen
authors.affiliation: Department of Psychiatry II, Ulm University, BKH Günzburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.affiliation: Cantonal Hospital, Marsens/Fribourg, Schwitzerland.
authors.forename: Graziella Giacometti
authors.initials: GG
authors.lastname: Bickel
authors.affiliation: Psychiatric Hospital, Augustenborg/Tønder, Denmark.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Bork
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cordes
authors.affiliation: Department of Psychiatry II, Ulm University, BKH Günzburg, Germany.
authors.forename: Karel
authors.initials: K
authors.lastname: Frasch
authors.affiliation: Aalborg Hospital, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Bent Ascanius
authors.initials: BA
authors.lastname: Jacobsen
authors.affiliation: Department of Psychiatry II, Ulm University, BKH Günzburg, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kilian
authors.affiliation: Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jens Ivar
authors.initials: JI
authors.lastname: Larsen
authors.affiliation: Services psychiatriques, Jura bernois - Bienne-Seeland, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lauber
authors.affiliation: Psychiatric Hospital Slagelse, Slagelse, Denmark.
authors.forename: Birthe
authors.initials: B
authors.lastname: Mogensen
authors.affiliation: Psychiatric University Hospital, Zurich, Switzerland.
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.affiliation: Research Center for Child Mental Development, Hamamatsu School of Medicine, Hamamatsu, Japan.
authors.forename: Kenji J
authors.initials: KJ
authors.lastname: Tsuchiya
authors.affiliation: Department of Organic Psychiatric Disorder and Emergency Ward, Aarhus University Hospital, Risskov, Denmark povlmunk@rm.dk.
authors.forename: Povl
authors.initials: P
authors.lastname: Munk-Jørgensen
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003299:Cooperative Behavior; D003718:Denmark / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D058006:General Practice; D005858:Germany / Q000453:epidemiology; D006296:Health Services; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D019964:Mood Disorders / Q000453:epidemiology*; D009549:Nigeria / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology*; D011570:Psychiatry; D012559:Schizophrenia / Q000453:epidemiology*; D012947:Social Work; D013557:Switzerland / Q000453:epidemiology
keywords: Pathway to care; collaboration; physical disease; psychiatric illness