Psychosomatics 43:24-30, February 2002
© 2002 The Academy of Psychosomatic Medicine
Medical Comorbidity in Psychiatric Inpatients
Relation to Clinical Outcomes and Hospital Length of Stay
Constantine G. Lyketsos, M.D., M.H.S.,
Gary Dunn, R.N., M.S.N.,
Michael J. Kaminsky, M.D., and
William R. Breakey, M.D., FRCPsych.
Received April 18, 2001; revised September 1, 2001; accepted September 6, 2001. From the Neuropsychiatry Service, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, MD. Address correspondence and reprint requests to Dr. Lyketsos, The Johns Hopkins School of Medicine, 600 North Wolfe St, Osler 320, Baltimore, MD 21287. E-mail: kostas{at}jhmi.edu
Medical comorbidity is common in psychiatric inpatients and may be associated with substantial impairment and mortality. Few studies have examined the relation between this comorbidity and psychiatric outcomes. A series of 950 admissions to the Johns Hopkins Hospital Phipps Psychiatric Service were rated by attending psychiatrists at admission and discharge on symptom and functional measures. A subset was also evaluated on the General Medical Health Rating, a valid and reliable measure of seriousness of medical comorbidity. Attending psychiatrists were also asked at discharge whether medical comorbidity had been a focus of care during the hospitalization; medical comorbidity had been a focus of care in about 20% of the patients. Serious active medical comorbidity was present in 15% of patients on admission and 12% at discharge. Medical comorbidity was associated with a 10%–15% increase in psychiatric symptoms and functional impairment at discharge, even after adjustment for admission clinical status. In addition, when comorbidity had been a focus of care during the hospitalization, length of stay was prolonged by 3.25 days on average. Medical comorbidity has measurable effects on the psychiatric outcomes of psychiatric inpatients and in some cases prolongs hospital stay. Psychiatrists should redouble their efforts to detect and treat this comorbidity and should consider whether special inpatient units might be needed to care for psychiatric patients with complex medical comorbidity.
Key Words: Diagnostic Tools • Comorbidity
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