Psychiatric aspects of somatic immunity; differential incidence of physical disease in the histories of psychiatric patients.

Abstract

There have been few studies in the past of the incidence of physical disease in the mentally ill relative to that of the general population. Many writers have pointed to the concurrent or subsequent development of such disorders as pulmonary tuber culosis or enteric fever during the sojourn of psychiatric patients in mental hospitals, and there are a considerable number of reports from physicians concerning the intercurrence of mental symptoms in a variety of infections, traumata, tumours, intoxications, and other stressful experiences. This latter literature has been referred to in another communication (Lovett Doust, 1952), and an assessment of physical disorders present in patients admitted to a mental hospital has been made by Phillips (1937). In addition to these observations, a small number of studies have been concerned with the relative frequency of physical complaints in neurotically disturbed patients (Eysenck, 1947), with the length of convalescence of psychiatric patients afflicted by various bodily illnesses (Brodman and others, 1947a), and with the increased tendency of apparently mentally healthy patients hospitalized for physical illness to show neurotic scores on a psychological test (Cornell Service Index) as compared with other subjects who had not broken down (Brodman and others, 1947b). The current interest in the general adaptation syndrome of Selye (1950), as it affects the capacity for homeostatic adaptation of mentally-ill patients (Hoagland and Pincus, 1950) has been extended into the field of immunity, especially by the work of Dougherty and others (1945) on changing lymphocyte counts, these cells being thought to be concerned in immunity production (White and Dougherty, 1946). It is clinically not infrequent that both the general physician and the psychiatrist have the opportunity of witnessing what may be called the alternation of psychiatric and somatic disease in the course of the illness of an individual patient. This alternation may take the form, for example, of a confusional episode associated with pneumonia and occur before, during the height of, or after the pyrexia; it may be observed in the form of a psychotic reaction, similar in symptomatology and appearance to an "idiopathic" psychiatric syndrome, perhaps as the sequela of an attack of influenza or of an apparently normal pregnancy and labour; or it may occur as a somatic illness during the investigation and treatment of a mental disturbance and present as bronchial asthma, rheumatoid arthritis, etc. (Appel and Rosen, 1950). The present paper stems from the clinical impression in the wards of a psychiatric 49