Screening CMHC outpatients for physical illness.

To assess the prevalence of physical disorders among outpatients treated in Colorado's public mental health system, a total of 175 patients from two community mental health centers received a comprehensive medical screening that included a standard physical examination and laboratory analyses. Of these patients, 46 percent had physical conditions or laboratory test results warranting further medical evaluation. A previously undiagnosed physical health problem was identified in 20 percent of the screened patients, and about 16 percent had conditions that could cause or exacerbate their mental disorder. The authors conclude that public mental health systems should ensure routine assessment of the physical health of psychiatric outpatients and suggest guidelines for developing medical screening procedures in public settings.

Milieu reactions to ECT.

Electroconvulsive therapy (ECT) evokes strong emotional reactions and disagreements among mental health professionals, patients, and families. The indications for ECT, its efficacy and sequelae, theories of its mechanism of action, social and political debate, and the technique itself have all been sources of controversy. In the forty years since its advent, knowledge of these issues has evolved. The efficacy of ECT in major depressive illness is now well established, but at the same time we can eliminate most of the fifty theories that Gordon listed in 1948 to explain how ECT works. While the mechanism of action appears likely to be a neurochemical one, it is far from being clearly understood. But is is not just uncertainty about how ECT works that remains. Not only are there arguments among the lay public, but even knowledgeable mental health workers are sharply divided in their opinions of ECT (Frankel et el. 1978). We believe that even when ECT is administered in a humane manner with informed consent to appropriately selected patients who derived lasting benefit without major sequelae, it will continue to evoke strong emotional reactions in therapists, patients, and ward staff. In this paper, some of the continuing controversy surrounding ECT is examined through reactions to it in the therapeutic milieu among therapists, staff, and patients. We hypothesize that ECT can be especially upsetting because it often produces rapid improvement in patients who had previously not responded to treatment. This tends to create an inflated estimation of ECT. Devaluation of other therapeutic modalities, staff splitting, and disruptions in the therapeutic alliance may follow. We present two cases to exemplify aspects of how the milieu reacts to ECT, and conclude with recommendations to improve the delivery of treatment.

Screening for adult phenylketonuria in state psychiatric hospitals.

The authors report the results of screening patients admitted to a state psychiatric hospital for unrecognized adult phenylketonuria. The results suggest that unrecognized adult phenylketonuria is very uncommon in these patients.

Treatment of chronic pain in the general psychiatric hospital.

Patients with chronic pain present many diagnostic and therapeutic challenges to primary physicians and psychiatric consultants. The authors present a series of twelve patients with chronic pain who were hospitalized on the psychiatric ward of a general hospital. Ten of the twelve patients presented decreased their medication use and were markedly improved at the end of their brief stay. Treatment goals, attitudes and interventions are discussed.

Implementation of laboratory screening procedures on a short-term psychiatric inpatient unit.

A health maintenance screening procedure was done on blood and urine specimens on 636 patients admitted to short term adult psychiatric ward. The data obtained was assessed by laboratory test and by its effect on the subsequent work-up and diagnostic thinking about those patients who had unexpected abnormal findings. The overall incidence of unexpected abnormal tests was low (3.0%). Similarly the incidence of new disease found by these procedures was low (between 2.2% and 8.5%). In no case was an underlying medical cause for the mental disorder for which the patient was admitted detected by the screening procedure. The authors conclude that these routine blood and urine screening tests add very little to the care of psychiatric inpatients.

A favorable response to lithium carbonate in a "schizo-affective" father and son.

It has recently been suggested that patients with mania are often misdiagnosed as having schizophrenia. The authors report a favorable clinical response to lithium carbonate in a father and son with an apparent schizo-affective syndromes may respond favorably to lithium but caution that a favorable response in such cases does not absolutely confirm a diagnosis of mania.