Lab and Ancillary Procedures

Question 1

___ is always asked

Answer 1

thyroid function

Question 2

neurological conditions that can have psych symptoms

Answer 2

• cerebrovascular accident
• epilepsy
• neoplasms
• dementia

tests: ct/mri

Question 3

endocrine conditions that can have psych symptoms

Answer 3

• hypothyroidism

- hyperthyroidism

Question 4

metabolic or systemic conditions that can have psych symptoms

Answer 4

• fluid and electrolyte imbalance

- encephalopathies

Question 5

toxic conditions that can have psych symptoms

Answer 5

• intoxication

- always rule out substance abuse!

Question 6

nutritional conditions that can have psych symptoms

Answer 6

• vit b12 deficiency (pernicious anemia)

Question 7

infections that can have psych symptoms

Answer 7

aids and neurosyphilis (ask sexual history!)

Question 8

autoimmune conditions that can have psych symptoms

Answer 8

• sle

- nmda receptor encephalitis

Question 9

neoplastic conditions that can have psych symptoms

Answer 9

pancreatic carcinoma

Question 10

basic screening tests

Answer 10

• cbc: anemia, platelet levels
• renal fn: urinalysis, creatinine, bun
• liver fn: alp, ast, ggt
• thyroid fn
• electrolytes
• glucose
• lipid profile
• ecg

Question 11

___ are contraindicated if bleeding is likely

Answer 11

ssri

Question 12

significance of electrolytes

Answer 12

• ssri = hyponatermia

- antipsychotics = hypokalemia

Question 13

significance of glucose testing

Answer 13

• baseline for side effects
• hypoglycemia
• 2nd gen antipsychotics = metabolic problems

Question 14

significance of ecg

Answer 14

• cardiotoxicity from medications

- anxiety vs mi

Question 15

neuroendocrine tests

Answer 15

• thyroid
• prolactin
• catecholamines

Question 16

lithium can lead to ___

Answer 16

hypothyroidism

Question 17

___ can elevate prolactin levels

Answer 17

second gen antipsychotics (dopamine receptor antagonists)

• prolactin is inhibited by dopamine
• presentation: amenorrhea, galactorrhea, gynecomastia

Question 18

significance of catecholamine testing

Answer 18

• low serotonin metabolite 5-hiaa is associated with violence
• high ne and e = ptsd

Question 19

kidney and liver function tests

Answer 19

• bun and creatinine

- important for pts on lithium

Question 20

blood tests for std

Answer 20

• vdrl (syphilis)
• cns-vdrl: neurosyphilis
• fta-abs: antibodies for t pallidum
• hiv test

Question 21

tests for benzodiazepines

Answer 21

• liver function

- urine drug screen (addiction)

Question 22

tests for antipsychotics

Answer 22

• cbc: clozapine can cause for agranulocytosis
• weekly cbc and then every 2 weeks for first 6 mos
• liver/kidney fn
• ecg

Question 23

tests for tcas

Answer 23

• cardiotoxic: ecg

Question 24

tests for mao-i

Answer 24

• baseline bp

- can cause serotonin syndrome

Question 25

tests for carbamazepine

Answer 25

- anticonvulsant, mood stabilizer - pre-treatment cbc with plt - liver fn for hepatotoxicity

Question 26

tests for valproate

Answer 26

- liver fn (hepatotoxicity)

Question 27

tests for lithium

Answer 27

- gold standard for bipolar disorder! - baseline cbc, electrolytes, ecg, tft, renal fn - fbs - pregnancy test!! - sodium depletion = toxic lithium levels - therapeutic range: 0.6-1.2 mEq/L - toxic levels: >2.0 mEq/L

Question 28

when to do lumbar puncture

Answer 28

- sudden onset of psych symptoms | - fever + neuro symptoms = meningitis

Question 29

time detectable of drugs in urine

Answer 29

- amphetamine 48h - barbituates 24hrs - 3 wks - benzodiazepine 3d - cannabis 3d to 4wks - cocaine 6-8 hrs - opioids 36-72 hrs