II. Indications
- Laboratory testing is dependent on presentation
- Labs are not required when the evaluation is fully consistent with Primary psychosis
- Known psychiatric history, age <35 years and normal Vital Signs support Primary psychosis diagnosis
- At least a finger-stick bedside Glucose is typically obtained in all emergency presentations of Psychosis
- Consider labs and diagnostics when risk factors are present
- No known psychiatric history (or first Psychosis presentation)
- Presentation after age 35 years
- Abnormal Vital Signs
III. Labs
- First-line tests
- Finger-stick bedside Glucose (all patients)
- Complete Blood Count
- Comprehensive metabolic panel (Electrolytes, Glucose, liver and renal tests)
- Serum B12 Level
- Thyroid Stimulating Hormone (TSH)
- Toxicology Screening
- Background
- Drug testing has low utility in acute psychiatric evaluations when added to a good history and exam
- In awake and cooperative patients, drug testing is unhelpful in medical clearance
- Casey (2023) Front Psychiatry 14:1209450 +PMID: 37492063 [PubMed]
- Kroll (2013) Psychosomatics 54(1):60-6 +PMID: 23194932 [PubMed]
- Common tests
- Blood Alcohol
- Urine Toxicologic Screen
- Unknown Ingestion testing is considerably more broad (e.g. Acetaminophen level, Salicylate level, VBG)
- Background
- Other tests to consider
IV. Imaging
- Head Imaging Indications (CT Head, MRI Brain)
- New, severe, refractory Headache
- Focal neurologic deficit
- Head Trauma
V. References
- (2013) DSM V, American Psychiatric Association, p. 99
- Holder (2014) Am Fam Physician 90(11): 775-82 [PubMed]