[Undetected physical diseases in new psychiatric admission]

We report on clinical observations from a 10-bed psychiatric acute ward where predominantly patients with concurrent physical diseases are treated. Of 287 patients admitted within 18 months we detected serious physical illness previously unrecognized or at least not sufficiently diagnosed in 15 cases (5.2%; age 17-88 years; 4 m, 11 f). Six patients suffered from acute neurological disease. One or more extracerebral disorders were found in nine cases. 14 of the 15 patients presented with organic mental syndromes classified according to ICD-9 (acute organic psychosis: n = 8, chronic organic psychosis: n = 6). The physical diseases unknown at admission were the only cause of the acute organic psychoses while they were contributing to the development of psychiatric symptoms in the majority of the other patients. In 14 patients the diagnosis of the previously unrecognized illnesses led to a significant change of therapy. At discharge 10 patients had improved with regard to their somatic and mental state while in two cases only the physical symptoms had remitted. One patient remained completely unchanged and two patients died from their serious diseases. Our case studies illustrate the fact that a relevant proportion of newly admitted psychiatric patients suffers from life-threatening medical illnesses. These require prompt and specific interventions and can only be detected by early and thorough physical examination.