Today our topic of discussion is Psychiatric Investigation.
Psychiatric Investigation
PSYCHIATRIC INVESTIGATION
The growing awareness of various physical conditions which can produce psychiatric symptoms and the increased use of biological therapies have made it mandatory that appropriate physical investigations should be carried out before starting any treatment and during it. They serve diagnostic, basal screening and monitoring purposes.
Routine Tests
- A complete hemogram (total and differential blood count, haemoglobin, ESR) and urinalysis are the basic minimum of routine test. Leucopenia and agranulocytosis are associated with certain medications. Treatment with lithium and neuroleptic malignant syndrome are often associated with leukocytosis
- Fasting and post-prandial blood sugar, chest X-ray and an EEG are often considered routine tests
- An EEG is necessary for monitoring cardiac effects of certain drugs.
- Serum electrolytes (sodium, potassium chlorides, bicarbonates, calcium, etc.) are sometimes needed as basal routine investigations. An electrolyte imbalance causes various neuropsychiatric symptoms like delirium
- Liver function tests: Serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), serum alkaline phosphatase, prothrombin time, serum bilirubin levels and serum proteins (total and differential) are some common liver function tests. Liver function tests are done for all alcoholic patients.
- Renal function tests: Blood urea, serum creatinine and creatinine clearance, thyroid function tests (T3, T4 and TSH) and ECG are routinely done on patients prior to starting lithium therapy.
- Serum lithium is assessed periodically to monitor patient receiving lithium therapy
- An ECG and chest X-ray are usually done before a patient is posted for ECT.
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