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The mental health needs of disaster victims remains a largely neglected area, possibly due to other pressing demands placed on available resources and to the difficulties in correctly detecting psychiatric cases by the general health worker. This study attempted to use a questionnaire suitable to primary care settings for the detection of probable psychiatric morbidity among 177 adult survivors of the disaster that destroyed the town of Armero, Colombia in November, 1985. The sample was initially screened with the Self-Reporting Questionnaire. A subgroup of 104 persons was subsequently interviewed by clinical psychiatrists to assess the specific nature of the psychiatric problems and to produce Diagnostic and Statistical Manual of Mental Disorders (DSM-III) diagnoses. The results of the screening and the psychiatric interviews were compared to evaluate the sensitivity, specificity, and predictive validity of the instrument. The results indicated that the instrument was highly sensitive (.87) and predictive of a positive result (.81), with a slightly lower score on specificity (.67). Incorporating this instrument in the training of the primary care worker for the detection of psychiatric morbidity among disaster victims could prove useful. (Author/NB)

Although the occurrence of medical illnesses in psychiatric patients is quite high, medical illnesses manifested by psychiatric symptoms are often overlooked. The higher mortality rates among psychiatric patients when compared to the general population may be a reflection of neglect or inadequate treatment of the psychiatric patients' medical problems. Since visits by psychiatric patients to community mental health centers (CMHCs) are usually more frequent than their visits to medical clinics, it becomes a responsibility of CMHCs to monitor their patients' physical problems and to develop effective community treatment plans. To further examine this issue, all active cases of schizophrenia (N=358) and neurosis (N=69) under care at the Johns Hopkins Hospital CMHC were reviewed. Patients' physical problems recorded on their admissions charts over the past 15 years were analyzed and operationally divided into major and minor physical diagnosis. The results revealed a significant difference between groups with respect to reported physical problems, as 38% of schizophrenics and 53% of neurotics had a physical problem recorded on their admission forms. Although a significantly higher proportion of neurotic patients reported physical problems, when problems were categorized by severity, the physical diagnoses reported by schizophrenics were significantly higher in the major category. For schizophrenic patients, issues such as coordination of care, drug interactions, medicinal side effects, and patient compliance must be considered carefully. (NB)