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Tests for patients with psychiatric symptoms
What basic workup is recommended for patients presenting with psychiatric signs and symptoms and what additional exams or tests may be considered
Laboratory Tests and Other Studies Useful for Psychiatric Symptom Workup
| Test | Purpose/Clinical Situation/When to Consider |
|---|---|
| ∗ Physical exam: including complete neurologic exam, vital signs, height and weight (BMI), waist circumference | All patients; observe for focal deficits; exclude medical problems; establish a baseline; monitoring |
| Basic labs: ∗ CBC, ∗ BMP, ∗ calcium, ∗ phosphorus, ∗ LFTs, lipids, ∗ UA, pregnancy test, hemoglobin A1c, ∗ vitamin B12, ∗ folate, vitamin D, blood alcohol level, ∗ thiamine, ∗ urine toxicology screen | Routine evaluation of most psychiatric complaints (evaluate for medical illness and substance use) and baseline and routine monitoring of pharmacologic treatments |
| ∗ Prescription drug levels | Sub- or supratherapeutic effects (e.g., toxicity) |
| Medication levels | Sub- or supratherapeutic effects (e.g., toxicity); especially for medications with narrow therapeutic windows such as lithium, valproate, clozapine, and tricyclic antidepressants |
| ∗ Thyroid function tests (TFTs) | Mood or anxiety symptoms, dementia, lithium monitoring |
| Serology for ∗ HIV , ∗ syphilis (FTA-Abs), hepatitis C, and Lyme | Routine screening; suspicion of infectious etiology |
| ∗ ESR, ∗ antinuclear antibodies, consider other serum or CSF antibody studies (e.g., anti-NMDAR antibodies) | Evaluate for inflammatory, autoimmune, and paraneoplastic disorders |
| ∗ Ceruloplasmin | Evaluate for Wilson’s disease |
| Genetic analysis | Rule out a genetic disorder (e.g., Huntington’s disease). Pharmacology selection (identification of cytochrome P450 or COMT hyper- or hypometabolizers) |
| Electrocardiogram (ECG) | For monitoring of QT interval effects of medications and arrhythmias contributing to panic symptoms |
| Chest X-ray (CXR) | Delirium and paraneoplastic workup |
| Lumbar puncture (LP) | CNS infections, autoimmune encephalopathy; consider in delirium and psychosis workup |
| Neuroimaging (CT, ∗ MRI, PET, etc.) | Evaluate for CNS pathology (e.g., stroke, tumor, demyelination, atrophy, proteinopathies, etc.) |
| Electroencephalography (EEG) | Confusion, history, or clinical suspicion for seizure, narcolepsy, or head injury |
| Polysomnography (sleep study) | Sleep apnea, restless legs syndrome, etc. |
| Neuropsychologic testing | Assess intelligence, memory, language, executive function, and better characterize psychiatric diagnosis |
Bolded items are recommended for general workup for most psychiatric symptoms, baseline, and treatment monitoring.
∗ Recommended in the routine workup of first-break psychosis. BMI , Body mass index; CBC , complete blood count; BMP , basic metabolic panel (including electrolytes, glucose, blood urea nitrogen, creatinine); LFTs , liver function tests; UA , urinalysis; HIV , human immunodeficiency virus (e.g., immunoassay); CSF , cerebrospinal fluid; ESR , erythrocyte sedimentation rate; FTA-Abs , fluorescent treponemal antibody absorption (RPR is insufficient); NMDAR , N -methyl- d -aspartate receptor; COMT , Catechol-O-methyltransferase; CNS , central nervous system; CT , computed tomography; MRI , magnetic resonance imaging; PET , positron emission tomography.
Sources
Data from American Psychiatric Association: Psychiatric evaluation of adults, 2nd ed. Am J Psychiatry 163(6 Suppl):3–36, 2006; Freudenreich O, Schulz S, Goff DC. Initial medical work-up of first-episode psychosis: a conceptual review. Early Interv Psychiatry 3(1):10–18, 2009.
