Page 32 - Complementary and Alternative Medicine Treatments in Psychiatry

32 | Complementary and Alternative Medicine Treatments in Psychiatry

In laying the groundwork for the report, Koran reviewed a
study of medical exams performed in county mental health
programs, which has been carried out by order of the state
legislature (Senate Bill [SB] 929). They found:
− Nearly two out of five patients (39%) had an active,
important physical disease.
− The mental health system had failed to detect these diseases
in nearly half (47.5%) of the affected patients.
− Of all the patients examined, one in six had a physical
disease that was related to his or her mental disorder, either
causing or exacerbating that disorder.
− The mental health system had failed to detect one in six
physical diseases that were causing a patient’s mental
disorder.
As a cost-effective measure to reduce these diagnostic errors,
Koran and his associates developed an algorithm—a step-by-step
procedure—to efficiently narrow down the likelihood of medical
disease in psychiatric patients. While the algorithm does not
replace a full, searching medical exam, it may be an appropriate
choice where funds, time, or patient access are limited. It may
also be an appealing alternative for current mental health
programs that offer no exam at all.
The algorithm is presented in Figure 2-1 exactly as originally
presented in the 1991 report. Some of these procedures may not
reflect developments in lab testing since the Field Manual was
written, but the fundamentals remain the same and adaptations
to current practices are simple enough.