LABORATORY TESTS IN

PSYCHIATRY

Ramon S. Javier, MD
University of Santo Tomas
Faculty of Medicine & Surgery
Deparment of Neurology and Psychiatry
• 1. To complete a general medical
workup of the sort done routinely for
any hospital admission

• 2. To rule out non-psychiatric causes of

the presenting symptoms

• 3. To conduct a specific work-up

appropriate for a specific treatment that
has been planned
• 4. To obtain information that will assist
in making a differential diagnosis
among several different mental illnesses

• 5. To assist in determining
pathophysiology, estimating prognosis,
and formulating a treatment plan.
I. GENERAL MEDICAL WORKUP

• standards vary in different hospital

settings
• CBC, FBS, BUN, Creatinine, liver enzymes,
serum electrolytes
• Chest X-ray, ECG
II. TO RULE OUT . . . . .

‘organic’ vs ‘functional’
Conditions Considered in the Differential
Diagnosis of Major Mental Illnesses

• Multi-infarct Dementia
• Subdural Hematoma
• Normal-Pressure Hydrocephalus
• Tumors
• HIV-related Dementia
• Temporal Lobe Epilepsy
• Endocrine/Metabolic Disorders
Multi-infarct Dementia
Subdural Hematoma
Normal-Pressure Hydrocephalus
Tumors
HIV-related Dementia
Temporal Lobe Epilepsy
Endocrine/Metabolic Disorders
Conditions Considered in the Differential
Diagnosis of Major Mental Illnesses

• Exposure to Toxins
• Vitamin Deficiency Syndromes (eg
pernicious anemia)
• Other CNS infections (TBM, syphilis)
Conditions Considered in the Differential
Diagnosis of Major Mental Illnesses

• Substance-induced Symptoms
• Neuropsychiatric effects of medical
treatment (eg K depletion from diuretics,
fatigue from propranolol, digitalis toxicity,
Phenytoin toxicity)
III. PERTAINING TO A SPECIFIC TYPE
OF TREATMENT

• to determine & document the pt’s physical

condition before the tx
• to rule out conditions that might be
adversely affected by the treatment
• to establish baseline values for the pt
before instituting treatment
ECT

• routine chemistries, urinalysis

• ECG – baseline cardiac status
• if with questionable signs of dementia ->
further workup
LITHIUM Therapy

• BUN, serum creatinine, serum

electrolytes, urinalysis
• T3, T4 levels
• ? ECG (age)
• serum lithium levels
ANTIPSYCHOTIC Therapy

• no special work-up prior to therapy

• if poor response -> blood levels
(haloperidol, clozapine, CBZ, VPA)
• clozapine & blood dyscrasias
ANTIPSYCHOTIC Therapy

• clozapine, olanzapine & weight gain

• genetic subtyping for cytochrome P450
allele
• SPECT, PET – visualize & measure density
of D2 receptors
ANTIDEPRESSANT Therapy

• no special work-up prior to therapy

• tricyclics – ECG
• poor response
– blood levels
– no imaging techniques available yet
IV/ V. TO ASSIST IN PSYCHIATRIC
DIFFERENTIAL DIAGNOSIS and

TREATMENT
PLANNING
• Various neuroimaging and psychological tests
• Determines the overall integrity of brain
function, the presence of structural
abnormalities, or the presence of generalized
intellectual deficits or specific learning disabilities
Abnormalities Commonly Seen
in Schizophrenia

• Ven tri cula r enl ar ge ment

• Prominent cortical sulci
• Decreased cerebral size
• Decreased frontal / temporal /thalamic / etc
size
• Increased caudate/putamen size
• Midline developmental abnormalities
Indications for CT Scan or MRI

• Confusion and/or dementia of unknown cause

• First episode of a psychotic disorder of unknown
etiology
• First episode of a major mood disorder after age
50 years
• Marked personality change after age 50 years
Indications for CT Scan or MRI

• History of recent head trauma

• Anorexia nervosa with marked weight loss
• Alcoholism or other substance abuse
disorder with signs and symptoms of
cognitive deterioration
 Some clues suggestive of organic mental
disorder

1. Psychiatric symptoms after age 40

2. Psychiatric symptoms
a. during a major medical illness
b. while taking drugs that can cause mental
symptoms
3. History of
a. alcohol or drug abuse
b. physical illness impairing organ function
c. taking multiple prescribed or over-the-counter
drugs
4. Family history of
a. degenerative or inheritable brain disease
b. inherited metabolic disease (eg, diabetes,
pernicious anemia, porphyria)
5. Mental signs including
a. altered level of consciousness
b. fluctuating mental status
c. cognitive impairment
d. episodic, recurrent, or cyclic course
e. visual, tactile, or olfactory hallucinations
6. Physical signs including
a. signs of organ malfunction that can affect the brain
b. focal neurologic deficits
c. diffuse subcortical dysfunction ( slowed speech /
mentation / movement, ataxia, incoordination, tremor,
chorea, asterixis, dysarthria)
7. Cortical dysfunction ( dysphasia, apraxias, agnosias,
visuospatial deficits, or defective cortical sensation)
Provocative tests for Panic Disorder

Intravenous lactate infusions – reported to induce

panic attacks
(+) in 70 % – 90 % of pts with panic
disorder
(+) in 0 – 30 % of control subjects

Other substances: CO2, isoproterenol, beta-

carboline, yohimbine, & caffeine
 the future
• Genetic markers
• Biochemical markers – examination of potentially relevant
compounds found in blood, urine, CSF, skin
Body fluid markers – molecular compounds, eg., DA, 5HT, NE
& their metabolites ( HVA, 5-HIAA, MHPG), various neuropeptides
(endorphins, enkephalins) & biological compounds (IgM, plasma
melatonin)
Peripheral tissue markers:
blood – NT receptors, enzymes
platelets – MAO, alpha1-adrenergic receptors,
serotonin reuptake sites, H-labeled-imipramine binding sites
RBC – lithium transport mechanism, COMT
skin – fibroblasts – NT receptors, important transport
systems
THANK YOU