"الإضطرابات العقلية الناتجة عن الحالة الطبية العامة بين المرضى ممتدي الإقامة" ""MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION"" AMONG LONG STAY PATIENTS"

                                                      Mental disorder due to a general medical condition is characterized by the presence of mental symptoms that are the direct consequences of an underlying medical condition (Wise&Rundell,2002). Failure to identify these underlying causal medical conditions can be potentially dangerous because serious and frequently reversible conditions can be overlooked. Proper diagnosis of a psychiatric illness necessitates investigation of all appropriate medical causes of the symptoms( Drooker,2004). Psychiatric disorders due to general medical condition is observed in disease in these categories: neurological, metabolic and endocrine, infectious and inflammatory and nutritional deficiency (Currier, et al, 2005 ).

        General medical condition may be presented by different types of mental disorders : delirium, dementia, amnestic disorder, Schizophrenia, mood disorder, catatonic disorder, personality change (Caine & Lyness,2000).

        This assessment is not performed in a vacuum but occurs in the context of the patients medical history and physical examination. Laboratory studies supplement the history and examination. The goal of the assessment is to identify causative factors that contribute to the patients current symptoms. When psychiatric symptoms are found to be due to general medical condition, initial efforts are focused on the treatment of the underlying condition (Candel,et al,2oo3).

      The aim of the work is to review the available literature on ""mental disorders due to a general medical condition"", to diagnose ""mental disorders due to a general medical condition"" in long stay patients, and to highlight on the recommendations regarding those patients.

                       The sample composed of 100 patients (63 females  & 37 males)  presented the chronic patients (>5 years) in EL-Abbassia Hospital. The patients were selected by stratified random sample and diagnosed according DSM-IV TR.  if there is any evidence from history, physical examination or laboratory findings that disturbance is direct consequence of a general medical condition according to Hillard & Zitek (2004), further investigations were done.

        We found that  6% of the chronic mental disorders patients (>5 years) in EL-Abbassia Hospital are mental disorders due to general medical conditions (five females and one male). Hall (1978) found a medical cause for psychiatric symptoms in 9.1% of psychiatric patients. Evans et al (1995) reported that psychosis caused by a medical condition may be a single isolated incident or may be recurrent, cycling with the status of the underlying medical condition. Comorbidity between physical and psychiatric disorders in our sample revealed, four cases have anemia and only one case has  cauda conus lesion.

        On admission 5 out of 6 cases are misdiagnosed and only one case is diagnosed in our study. This agrees with Chandrasekaran et al (2005) who reported that organic Brain Syndromes (OBS) are often missed in clinical practice.

      Schizophrenia is the most common diagnosis (62%), then mood disorders (22%), organic mental disorders (6%) and other disorders (10%).  while personality disorders (borderline) is the least one (4%). This result agrees with Koran & Sheline (2002) that he found schizophrenia is the most common diagnosis   (62%), while mood disorders (24%), organic mental disorders (2%) and other disorders (2%). Unterberger & Reynolds (1969) reported that approximately one out of nine patients admitted to the Haverford psychiatric State Hospital was classified as having chronic brain syndrome.

        As regard the mental disorder due to a general medical condition, among the females two cases have organic delusional disorders (schizophrenia-like); one case due to Granulomata and the other due to old infarction, one female case has organic mood disorders due to temporal lobe epilepsy, one female case has epilepsy with psychotic features, one female case has mental retardation with psychotic features due to neural tube defect (generalized myopathy). The only male case has mental retardation with psychotic features due to tuberous sclerosis.

        Among the chronic cases (>5 years) in EL-Abbassia hospital there is highly statistically significant difference between males & females as regards the age distribution, the majority of the male and female patients are in the middle age group (35-50 y), followed by the youngest group (15-35y) among the female is (36%) and the oldest group (50-65y) among the male is (35%).

        The majority of male and female patients in EL-Abbassia hospital have no visits (36%), even when the patients receive visits they are rare; 27% of patients receive one visit per week, 30% receive one visit per month and 7% receive one visit per year. Also not all the visits are done by the family members, this appear the negative attitude of the family towards their mentally ill patients.

       Acute departments in EL-Abbassia hospital receive mostly male patients, but  chronic departments receive female patients more than male patients. EL-Abbassia Hospital has beds according to patients` number. Full bed capacity in acute departments for male patients are more than females and vice versa in chronic departments. This means that admission of male patients are mainly in the acute episodes and then they discharge after improvement. While female patients do not take the same support and care from their families, so they don’t

discharge and they transfer to the chronic department."