Liberty & Mental Health

Overlooked Medical Ailments in Psychiatric Populations - The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), cautions against using the manual in a cookbook fashion,13 yet many in the field of mental health use it exactly that way. The problem of overlooked medical ailments in psychiatric populations was so significant that by 1988 the California legislature mandated an exploration into a means of reducing the risk of missed medical conditions. Lorrin Koran, MD, of Stanford University was tasked with leading the development of a corrective procedure. The results of his team’s work were reported to the California Department of Mental Health and local mental health programs in 1991 as the Medical Evaluation Field Manual. The mental health system had detected 58 percent of test-group patients with a disease at a cost of $230 per patient. Many mental health programs are not staffed with physicians practiced in medical diagnosis and thus are unprepared to detect a large proportion of physical diseases in their patients. As described elsewhere, California’s state mental health programs fail to detect many diseases that could be causing or exacerbating psychiatric disorders. The Koran screening algorithm has several appealing characteristics: 1. It is limited to those findings that best predict the presence of physical disease in a sample of patients cared for within the California public mental health system. 2. It saves the effort and expense of gathering data that may not help in detecting physical disease. 3. The data used in the algorithm can be obtained by mental health staff and do not require a physician, nurse, or physician assistant. - The Koran medical algorithm requires ten items of medical history, measurement of blood pressure, and sixteen laboratory tests (thirteen blood tests and three urine tests). These data were the only strong predictors of physical disease in the Koran patients. - If California fails to find many diseases that cause or exacerbate psychiatric disorders, it’s a good bet that every state has people who are homeless, in jail, in prison, or in extreme poverty due to lack of proper diagnosis. - In 1995 a study found that from 5–40% of psychiatric patients have medical ailments that would adequately explain their symptoms. The next year, in 1996, Sydney Walker III, MD, a psychiatrist, in his book A Dose of Sanity, claimed studies have shown that from 41% to 75% of individuals are initially misdiagnosed, often due to overlooked treatable conditions. In 2009, it was found that up to 25% of mental health patients have medical conditions that exacerbate psychiatric symptoms. Yet most of the debate today centers on forcing drugs on individuals, not providing adequate diagnosis and effective treatment. Walker points out that the DSM has encouraged practitioners to label patients quickly rather than pursue the more time consuming deductive work of differential diagnosis. According to Walker, labeling leads to fitting patients into groups rather than treating them as the individuals they are, carefully taking medical histories, and performing physical examinations— all of which being absolute requirements for a valid diagnosis. Walker presents many appalling examples of patients who were routinely assigned DSM labels that then became masks for such often dangerous physical diseases as bowel blockage, lupus, brain tumors, and Tourette’s and Klinefelter’s syndromes. Walker stresses that many of the masked diseases are treatable if caught early and that many of the drugs psychiatrists prescribe are dangerous or addictive. Ruling out the various physical ailments that can cause or exacerbate psychiatric disorders needs to be done prior to labeling a person as mentally ill. This label negatively impacts individuals for decades after he or she has made a complete recovery—even if the label was applied erroneously.