[Psychiatric illness does not protect against a somatic disease]

In four patients, two women aged 68 and 73 years and two men aged 65 and 57 years, serious diseases were not recognised because of more prominent psychiatric symptoms. Three of the patients had malignancies and one was suffering from dehydration with a urinary tract infection and de novo diabetes mellitus. The patient with a meningioma recovered after surgery, the other three patients died despite treatment. Somatic diseases may not be recognised in patients with psychiatric illness because doctors may be more likely to ascribe the symptoms to a psychiatric cause. Patients may also present their symptoms in an unusual way. It is important not only to diagnose the psychiatric disease but also to check the patient's physical condition. This applies particularly to elderly patients, because they are more likely to have somatic diseases. Good education of psychiatrists in terms of somatic diseases remains important.