Thoracic Surgery in Mentally Ill Patients

Abstract

General Observations Adequate care of mentally ill patients presenting pulmonary disease (non-specific infections, lung abscesses, bronchiectases, empyema), malignant and benign tumors and the demands of an effective tuberculosis control program necessitate the application of thoracic surgery in hospitals for the mentally ill. It is worthy of note that the incidence of tuberculosis detected among patients admitted to the Illinois Department of Public Welfare’s 13 mental hospitals and the two schools for the mentally retarded is 29 times greater than the reported incidence in the general population.’ These institutions have an average total resident patient population of about 48,000. To serve this institutional system, thoracic surgical centers were set up at Kankakee State Hospital in 1951 and at Chicago State Hospital in 1954. A thoracic surgical service established in 1957 provides consultation and surgical service to all state welfare institutions. Under the present program, conferences at which the medical, surgical and roentgen departments are represented, screen the patients and on recommendation they are channeled to either of the two centers for final evaluation and treatment. The following is a report on the major thoracic surgery performed on mentally ill or retarded patients under the department’s auspices and at the Veterans Administration Hospital, Downey, Illinois, a 2,847-bed neuropsychiatric facility. The period covered is from October, 1947 through December, 1957, with follow-up ranging from one to eleven years. During this period there were 388 procedures performed on 343 patients with an overall post-operative mortality (within 90 days) of 23 patients (6.7 per cent). Eighty-six of these procedures were conducted at the Veterans Administration Hospital. These patients represent a cross-section of the various types of mental disease, including schizophrenics, chronic alcoholics with deterioration and senile dementias, epileptics and mentally retarded with and without psychosis. It must be emphasized that we are dealing surgically with the chronic mentally ill patient. An insight into the reluctance of the relative and a tactful approach to this problem are very necessary. For analytical purposes, the patients are divided into tuberculous and non-tuberculous categories. Many were not optimal risk candidates for surgery.