The purpose of this article is to present the special characteristics of the practice of surgery in a neuropsychiatric hospital which I have observed over the past 13 years.
The clinical significance of the lack of complaint by psychotic patients in acute medical and surgical disorders and the manner of taking the medical history, performing the physical examination, and instituting a plan of treatment with the patient suffering from a psychosis have previously been reported.1-3 The more important findings of these studies were as follows:
1. Acute myocardial infarction, acute perforated peptic ulcer, acute appendicitis, and fracture of the hip, which ordinarily have a sudden onset with severe pain, may frequently occur in psychotic patients without a complaint being offered.
2. Since subjective symptoms are usually lacking in the physically ill psychotic patient, careful observation of these patients for objective signs of physical illness