Unrecognised psychiatric illness in medical patients.

Unrecognised psychiatric illness in medical patientsOf the several papers published on unrecognised psychiatric illness in medical patients, most have appeared in psychia- tric journals and may not have come to the attention of general or specialist physicians.Nevertheless, in the Lancet review in 1979 the incidence of psychiatric illness reported ranged from 25% to 83%.' Clearly this figure depended on how psychiatric illness was defined and the type of hospital surveyed.Many of the papers reviewed had been by psychiatrists, who pointed to the failure of their general medical colleagues to recognise psychiatric problems in their patients.This judgment, however, was largely based on a scrutiny of the case notes, summaries, and doctors' letters to decide whether the psychiatric aspect had been recognised, and it may have underestimated the ability of the non-psychiatrist to spot a psychiatric component in a patient's illness.To make a balanced assessment three problems need to be considered.Firstly, how common is psychiatric illness in medical patients?Secondly, how important is it that it should be recognised and documen- ted?Thirdly, if it is important what can be done to ensure more frequent recognition?In a study in the particularly busy medical wards of the Radcliffe Infirmary in Oxford, 170 patients were given the general health questionnaire, and the 77 who had a score