Psychosis Lab Testing

Aka: Psychosis Lab Testing, Psychosis Labs, Psychosis Diagnostic Testing

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II. Indications

  1. Laboratory testing is dependent on presentation
    1. Labs are not required when the evaluation is fully consistent with Primary psychosis
    2. Known psychiatric history, age <35 years and normal Vital Signs support Primary psychosis diagnosis
    3. At least a finger-stick bedside Glucose is typically obtained in all emergency presentations of Psychosis
  2. Consider labs and diagnostics when risk factors are present
    1. No known psychiatric history (or first Psychosis presentation)
    2. Presentation after age 35 years
    3. Abnormal Vital Signs

III. Labs

  1. First-line tests
    1. Finger-stick bedside Glucose (all patients)
    2. Complete Blood Count
    3. Comprehensive metabolic panel (Electrolytes, Glucose, liver and renal tests)
    4. Serum B12 Level
    5. Thyroid Stimulating Hormone (TSH)
    6. Toxicology Screening
      1. Background
        1. Drug testing has low utility in acute psychiatric evaluations when added to a good history and exam
        2. In awake and cooperative patients, drug testing is unhelpful in medical clearance
        3. Casey (2023) Front Psychiatry 14:1209450 +PMID: 37492063 [PubMed]
        4. Kroll (2013) Psychosomatics 54(1):60-6 +PMID: 23194932 [PubMed]
      2. Common tests
        1. Blood Alcohol
        2. Urine Toxicologic Screen
        3. Unknown Ingestion testing is considerably more broad (e.g. Acetaminophen level, Salicylate level, VBG)
  2. Other tests to consider
    1. Syphilis Serology (RPR, VDRL)
    2. HIV Test
    3. Erythrocyte Sedimentation Rate
    4. C-Reactive Protein
    5. Antinuclear Antibody test
    6. Free Urine Cortisol
    7. Urine Copper
    8. Parathyroid Hormone

IV. Imaging

  1. Head Imaging Indications (CT Head, MRI Brain)
    1. New, severe, refractory Headache
    2. Focal neurologic deficit
    3. Head Trauma

V. References

  1. (2013) DSM V, American Psychiatric Association, p. 99
  2. Holder (2014) Am Fam Physician 90(11): 775-82 [PubMed]

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