Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population.

Major medical illnesses remain undiagnosed and patients' ailments are being labeled "psychosomatic" at an alarming rate. A careful screening of 2,090 psychiatric clinic patients showed that 43% of this population suffered from one or several physical illnesses. Almost half of the physical illnesses (46%), remained undiagnosed by the referring source. Morbidity in the psychiatric clinic patients far surpassed the expected rate found in the general population. Among others, diabetes mellitus was a frequently overlooked diagnosis and proved, particularly, to produce emotional disturbances. Physicians other than psychiatrists missed one third and psychiatrists one half of the major medical illnesses in patients they referred. Self-referred and social agency--referred patients almost always had undiagnosed physical illnesses. The causes for failing to recognize medical illnesses are discussed. Based on the obtained data, the necessity for a medical orientation on the part of psychiatrist in evaluating all patients is stressed.

Fatalities in 2,070 psychiatric outpatients.

During a three-year period 28 fatalities, twice the rate in the general population, were found in a sample of 2,070 psychiatric outpatients. Death occurred in these psychiatric patients approximately 20 years earlier than is expected. All three modalities of death: accidents, suicide, and natural causes, were higher than that in the population at large. Three suicides were thought to be preventable by psychiatric approaches. The importance of the patient's initial visits was stressed. At least four, and possibly five, cases of death were avoidable by appropriate medico-surgical means. The rate of physical illnesses in all three groups was more than 80%, of which one third were inadequately diagnosed by their referring physicians. The importance of the physical evaluation of psychiatric patients was emphasized.

Two cases of malaria presenting with psychiatric symptoms.

Mood and behavior disorder may appear either due to primary psychiatric disorder or may signify an underlying, frequently undetected, physical pathology. Two instances of malaria falciparum presenting with psychosocial symptomatology are described.

Mental retardation. Medical aspects.

This article reviews the medical aspects of mental retardation with a focus on classification, types of retardations, evaluation and therapies, and etiology.

Echinococcosis of the kidney.

A case of renal echinococcosis, most uncommon in Hungary, is reported. The problems of diagnosis and therapy are discussed. It is emphasized that difficulties of diagnosis, particularly differential diagnosis, arise mainly in countries where the incidence of echinococcosis is low. It is with the aid of the new diagnostic methods that an echinococcus cyst has been identified preoperatively in an occluded kidney which had been out of function for years.

The cortical dementias.

A striking accumulation of new technologies and recent diverse research developments open new insight into the nature of primary dementias. The gene of the familial form of Alzheimer's disease was located in the chromosome 21. By further study of the amyloid protein precursor gene, laboratory diagnosis and eventual treatment of Alzheimer's disease may become a reality. This paper reviews and adds perspective to old and new data on the cortical dementias: Alzheimer's disease and Pick's disease.

[Priapism]. / Zur Frage des Priapismus

The data of patients treated for priapism in the Department of Urology of Semmelveis University Medical School between 1951 and 1971 are analyzed. Eleven patients were hospitalized and three were outpatients. After a brief survey of the literature, mechanism, aetiology and treatment of the condition are discussed. In the majority of the patients after the cessation of priapism sexual libido returned as a rule without the appearance of erection. Three cases are briefly described. In four patients after some time partial erection and orgasm was experienced under mechanical influence. Two of these patients had married and have children.

Physical illnesses underlying psychiatric symptoms.

The authors reviewed 21 studies dealing with the rate of diagnosed and undiagnosed physical illnesses in the psychiatric patient population. These studies performed by different authors in variable clinical settings with diverse methodology in different locations over a period of 45 years yielded a close concordance. Approximately half of the patients (50.1%) suffered from significant physical illnesses, of these 58.2% were previously undiagnosed. A substantial portion of the physical illnesses (27.1%) produced symptoms showing direct relation to the psychopathology of the patient. These numbers are quite close to those found by authors in earlier research.

Altered amitriptyline kinetics in a depressed patient with porto-caval anastomosis.

A case of altered kinetics of amitriptyline in a patient with porto-caval anastomosis and liver cirrhosis who showed an unusually strong sedative response to the drug, is presented. Therapy with tricyclic antidepressants should be initiated with lower doses and adjusted by plasma level monitoring in patients with liver by-pass.

Alcohol withdrawal concealing symptoms of subdural hematoma--a caveat.

Symptoms of significant medical illnesses, in this case subdural hematoma, is easily overlooked in midst of alcohol withdrawal. Unusual symptoms must be regarded with caution.

[Urologic complications of pelvic fractures]. / Urologische Komplikationen bei Beckenfrakturen.

In 37 of the 258 patients with pelvic fractures rather severe urological complications were diagnosed. It seems that the majority of polytraumatized patients can be considered as potential urologic cases. The characteristic urological complications associated with the various types of fractures are described. The importance of urgent urological examination is stressed in order to detect urological injuries requiring acute care and to determine the need for operation or for conservative treatment. Co-operation between the traumatologist, the urologist and the radiologist will ensure the definitive care of the polytraumatized patient and the best chances for recovery.

Symptomless renal tumours diagnosed from their metastases.

After a brief review of renal tumours diagnosed on the basis of metastases, two cases are described in which subcutaneous formations believed to be lipomas were metastases of symptomless hypernephromas. One case was diagnosed early on basis of the histological finding. The primary tumour could be localized only by angiography. After nephrectomy and resection of the contralateral rib and pleura, the patient was free of symptoms for one year. In the subsequent year a pathologic subtrochanteric fracture called attention to a new metastasis. After laminar osteosynthesis function of the hip and knee joints was satisfactory and so has been the general condition ever since the first operation now for three years. In the second case, the knot assumed to be a lipoma was removed but no histological examination was carried out. These experiences have induced the authors to call attention to the importance of histological examination of apparently banal lesions and to the considerable survival which can be achieved in these patients.

[The modified Denis prostatectomy]. / Erfahrungen mit der modifizierten DENISschen Prostatektomie.

The favourable experience gained with the so-called modified Denis-type method is described. It is stressed that the method has all the advantages which are ensured by the Hencz-type haemostatic thread. In addition, the patient is spared many unpleasantness and post-operative complaints. Post-operative treatment is easier since a separate flow from the loge and from the bladder is provided for. The results of different methods are compared on the basis of 150 prostatectomies performed in the Department of the authors.