Routine laboratory tests in adolescent psychiatric inpatients: their value in making psychiatric diagnoses and in detecting medical disorders

Lack of clinical relevance of routine chest radiography in acute psychiatric admissions

To make clinically relevant recommendations for chest X-ray testing in acute psychiatric admissions, this study examined the current practice of this screening test in patients admitted to a University Hospital. The records of the 332 first consecutive admissions to the psychiatric ward were assessed. In 200 patients (60%) a chest X-ray was requested. The X-ray film was normal in 81.5% of patients. The remaining subjects presented abnormalities: nonrelevant in twenty-seven (13.5% of the total), and relevant in eleven (5.5%). Since all these relevant abnormalities were already known, in no cases was the test followed by changes in therapy or by additional diagnostic procedures. In almost all cases this screening test was of no practical value. Our findings challenge the systematic indication of chest X-ray in acute psychiatric patients, and suggest that the number of tests performed and the cost of medical care could be reduced by a more efficient use of past medical history and physical examination criteria, without compromising the quality of patient care.

Utility of thyroid function screening in adolescent psychiatric inpatients

OBJECTIVE

Thyroid function abnormalities have been associated with psychiatric symptoms. This study examines the utility of thyroid screening among adolescent psychiatric inpatients.

METHOD

A retrospective chart review of 196 first-time admissions to an adolescent psychiatric unit was conducted. Charts were screened for demographics, presence/absence of thyroid function testing, history of thyroid disease, medication/illicit substance use, and other factors of influence on thyroid testing. Thyroid test results were reviewed for abnormalities.

RESULTS

Thyroid function testing was conducted in 150 of the 196 admissions. Fifty-two patients had abnormalities, most of which were isolated abnormalities of thyroxine (T4) or triiodothyronine uptake (T3U). Laboratory diagnosis of hyperthyroidism and mild hypothyroidism was met by two and eight patients, respectively; five had profiles that were normal upon subsequent testing 1 week later. None of the patients was symptomatic, and none required thyroid supplementation or antithyroid medications. Gender differences in T4 and T3U were noted, and age was positively correlated with T3U.

CONCLUSIONS

Thyroid function tests may be spuriously abnormal in routine screening of newly admitted psychiatric patients. Routine thyroid screening among adolescent psychiatric inpatients is unwarranted except in patients who display physical signs or symptoms suggestive of thyroid disease.

Screening laboratory evaluation in psychiatric patients: a review

Routine laboratory screening of psychiatric patients is a common clinical practice. Several studies have demonstrated the limited utility and higher cost of ambulatory and preadmission screening in the evaluation of general medical patients. The data concerning the use of such screening profiles in psychiatric patients are reviewed. Widespread use of extensive screening batteries, consisting of complete blood cell count (CBC), complete blood chemistry analysis, erythrocyte sedimentation rate (ESR), urinalysis, B12, folate, electroencephalogram (EEG), electrocardiogram (EKG), and chest x-ray film, is not indicated in the majority of psychiatric patients. Such investigations result in many abnormal findings, most of which are clinically insignificant and do not affect patient management and outcome. Most abnormal results can be predicted by information obtained from a careful history, review of systems, and physical examination. Certain populations appear to benefit from more extensive evaluation, including those older than 65 years of age or of low socioeconomic status, state hospital patients, patients with drug and alcohol histories, and patients with evidence of disorientation, self neglect, or organic mental disorders. The few tests that have merit as broader screening tests in asymptomatic patients include serum glucose, blood urea nitrogen (BUN), creatinine, and urinalysis. Patients on psychotropic medications should be monitored for side effects of that particular therapy. Further prospective data are needed to develop cost-efficient, population-specific diagnostic strategies.

Assessment and diagnosis of mental illness in persons with mental retardation. Methods and measures

The assessment and diagnosis of psychiatric disorders in individuals with mental retardation has been a neglected area of research. However, current research indicates that these individuals suffer from the same range of psychiatric disorders that is evident in those who are not mentally retarded. A model of assessment and diagnosis of mental illness in this population is presented that incorporates psychiatric as well as behavioral methods. The emphasis is on the comprehensive assessment of an individual's behavior, based on family history, self and informant clinical interviews, rating scales, direct observations, and an experimental analysis of the target behaviors. The model provides the basis for making differential diagnoses in terms of related psychiatric disorders and between psychiatric disorders and behavior problems. Depression and schizophrenia are used as illustrative disorders to describe the application of this model. Given the paucity of literature on the assessment and diagnosis of mental illness in individuals with mental retardation, a number of suggestions are made regarding future research and refinement of the model.

Family background and physical health of adolescents admitted to an inpatient psychiatric unit, II: Physical health

The charts of 100 adolescents admitted to a special unit of a provincial psychiatric hospital were reviewed. These patients primarily had a conduct disorder (71.6% of boys and 77.5% of girls) or an affective disorder (6.6% of boys, 15.0% of girls). There was a higher incidence of congenital disorders in the population than expected, suggesting that such disorders may predispose to psychological troubles later in life. Convulsions also occurred more often in this population. Most patients (78.3% of boys and 85.0% of girls) had one or more medical diagnoses. Several potentially serious findings (anemia, pregnancy, hepatomegaly, thyroiditis) were first noted on the admission physical examination. Patients with conduct disorder had certain health problems that are likely to be the result of the psychiatric disorder, such as liver function changes in drug and alcohol abusers and abnormal Pap smears in sexually active girls with multiple partners. If these medical conditions are not followed and treated, they have the potential for causing serious problems at a later date. These findings point out the continued need for the expertise of psychiatrists and other physicians in children's mental health facilities.