Diagnosis and treatment of physical disease in the mentally ill.

The inability of patients to provide a history and to cooperate in physical or technological examinations makes the diagnostic and therapeutic management of physical disease in psychotic and especially in elderly psychotic patients very difficult. There needs to be a disproportionate dependence upon laboratory and radiologic information in diagnosis of physical disease in such patients. Observations by personnel on the psychiatric wards are essential to identification of probable physical illness. An experience with 1800 patients on a medical service now approved for Medicare and Medicaid in a state psychiatric hospital clearly shows the impossibility of applying the norms of care set for a general hospital in such a setting. Additionally, the clinician is faced with ethical considerations of which actions are justifiable and which are not in the search for a diagnosis. The Professional Standards Review Organization, judicial verdicts requiring care for the mentally ill equal to that of other citizens, and the hazards of professional liability do not permit these considerations to be taken lightly. An organization that has responsibility for the mentally ill might well address itself to finding answers to these questions.