Patients with serious mental illness in one state hospital sample had"
alarmingly" high rates of positive tuberculin tests, as well as
hepatitis B, C, and HIV serology tests, prompting researchers to call for
screening and vaccinating inpatients with serious mental illness.
To gather their data, researchers systematically reviewed data for the 655
patients who were admitted to the Erich Lindemann Mental Health Center in
Boston between January 1, 1997, and December 31, 1999.
That state psychiatric hospital admits patients who are referred through
the court system for forensic evaluations or are transferred from acute-care
Upon admission, patients meet with an infection-control nurse who discusses
risk factors for infectious diseases, coordinates disease testing, delivers
the results, and counsels patients who test positive for certain infections,
according to a report of the study in the December 2005 Psychiatric
A minority of those admitted over the three-year period were deemed too
psychiatrically impaired to be screened for infectious diseases or left the
hospital before they could be screened.
Researchers measured the frequency of positive tests for 535 patients who
received tuberculin tests, 62 who received HIV tests, and 548 who were tested
for hepatitis A, B, and C.
When compared with the general population, patients in the sample had four
times as many positive tuberculin tests (20.2 percent of those tested screened
In addition, 33.2 percent of patients tested positive for hepatitis A, 24
percent screened positive for hepatitis B, and 21.5 percent screened positive
for hepatitis C.
"The number of positive tests for hepatitis B and C among patients
screened were five and 12 times as great as population estimates,
respectively," the authors wrote.
Patients in the hospital sample had nine times the number of positive HIV
tests as those in the general population (almost 30 percent of those who were
screened tested positive).
The authors noted that a limitation of the study was that patients were
screened for markers and antibodies of the diseases rather than "active
or acute disease; some patients may have had illnesses in the past or even
immunization, which may result in positive tests." Patients who screened
positive for infectious diseases were referred to an internal medicine
specialist who examined patients further to determine whether they were
actually experiencing symptoms of the disease and treated them
However, the positive test results found during the study period prompted
hospital administrators to take action; due to the high number of positive
hepatitis C tests, the mental health center implemented routine screening for
hepatitis C antibodies among all patients admitted since 2000. According to
the report, patients who screened positive for tuberculin skin tests were more
likely to be older or homeless. They were also more likely to be
Patients with positive hepatitis B tests tended to be immigrants or have a
history of drug use.
Given the relatively high proportion of positive tests for infectious
diseases in the state hospital sample, primary investigator William Pirl,
M.D., emphasized that for some patients with serious mental illness,
psychiatric hospitalizations may provide the perfect opportunity for screening
and prevention of infectious diseases.
Pirl is an attending psychiatrist on the Psychiatric Oncology Service at
Massachusetts General Hospital and an instructor in psychiatry at Harvard
He also pointed out that for patients who are homeless or have chaotic
lives, "psychiatric care may be their default primary medical
While hepatitis B and C vaccinations require several injections spaced
weeks or months apart, Pirl suggested that inpatients receive their first
vaccine during their hospitalization and arrange "outpatient medical
care to complete the vaccinations."
"Screening for Infectious Diseases Among Patients at a State
Psychiatric Hospital" is posted at<http://psychservices.psychiatryonline.org/cgi/content/full/56/12/1614>.▪