Kampmeier R H
Ann Intern Med. 1977 May;86(5):637-45. doi: 10.7326/0003-4819-86-5-637.
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.
患者无法提供病史以及在体格检查或技术检查中不配合，这使得对精神病患者尤其是老年精神病患者的躯体疾病进行诊断和治疗管理变得非常困难。在诊断此类患者的躯体疾病时，需要过度依赖实验室和放射学检查信息。精神科病房工作人员的观察对于识别可能的躯体疾病至关重要。在一家州立精神病医院，对1800名现已纳入医疗保险和医疗补助计划的内科患者的诊治经验清楚地表明，在这种环境下无法应用为综合医院设定的护理标准。此外，临床医生在寻求诊断时面临着伦理考量，即哪些行为是合理的，哪些是不合理的。专业标准审查组织、要求给予精神病患者与其他公民同等护理的司法判决以及职业责任风险，都不允许对这些考量掉以轻心。一个对精神病患者负有责任的组织很可能会致力于寻找这些问题的答案。
