Managing complex patients on a medical psychiatric unit: an observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention.
Physical and mental illnesses commonly occur together. The quality of physical care in institutions for mental health in the Netherlands is not guaranteed. The cases of a 63-year-old woman with a schizoaffective disorder and diabetes mellitus who became delirious after surgery and a 76-year-old suicidal man with a psychotic disorder due to hydrocobalamine deficiency after major heart surgery show that the so-called medical-psychiatric unit, which is a part of the Psychiatric Department of a general hospital, may have several advantages in the treatment of combined physical and mental disorders. Both patients were admitted to such a unit. In this way, the internist of the first patient could continue to treat her and she could be treated with an infusion, urinary catheter and gastric intubation; in addition, laboratory investigations could be performed. The second patient, whose safety required primary attention, could also be treated for his somatic disorders and a delirium could be ruled out. His family was assisted in recovering from their traumatic life experience caused by his suicide attempt.