Investigation in psychiatry
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  • 1. INVESTIGATIONINPSYCHIATRYMR. JAYESH PATIDARwww.drjayeshpatidar.blogspot.com
  • 2. INTRODUCTION…• Investigation are useful to detect alterationin biologic function & to screen for medicaldisorders causing psychiatric symptoms.• Classification of investigation:I. Routine InvestigationII. Electrophysiological TestsIII. Brain Imaging TestsIV. Neuro-endocrine TestsV. Genetic Testswww.drjayeshpatidar.blogspot.in
  • 3. I. Routine Investigation:• A complete hemogram (total & differential bloodcount, hemoglobin, ESR) & urine analysis are basicroutine tests. Leucopenia & agranulocytosis areassociated with certain medications (clozapine).Treatment with lithium & neuroleptic malignantsyndrome are often associated with leucocytosis.• Renal function tests: Treatment with lithium.• Liver function tests: For all alcoholic patientstreatment with carbamazepine, valproate &benzodiazepines.www.drjayeshpatidar.blogspot.in
  • 4. Count…• Serum electrolytes: Dehydration, treatment withcarbamazepine, antipsychotics, lithium• Blood glucose: Routine screen above 35 years age• Thyroid function test: Depression, treatment withlithium & carbamazepine.• Electrocardiogram (ECG): Above 35 years ofage, treatment withlithium, antidepressants, ECT, antipsychotics.• HIV testing: IV drug users, suggestive sexualhistory, AIDS, dementia.• VDRL: Suggestive sexual historywww.drjayeshpatidar.blogspot.in
  • 5. Count…• Serum CPK: Neuroleptic malignant syndrome(markedly increased levels)• Chest X-ray: Before treatment with ECT• Drug level estimation: Drug levels are indicated totest for therapeutic blood levels, for toxic bloodlevels & for testing drug compliance. Examplesare lithium (0.6-1.6 mEq/L), carbamazepine (6-12mg/ml, valproate (50-100 mg/ml), haloperidol (8-18 mg/ml), imipramine (200-250mg/ml), etc)www.drjayeshpatidar.blogspot.in
  • 6. II. Electrophysiological Tests:• Electroencephalogram (EEG): Measuresbrain electrical activity, identifiesdysrhythmias & asymmetric, used in thediagnosis ofseizures, dementia, neoplasm, stroke, metabolic or degenerative disease.• Polysomnography/sleep studies: Used inthe diagnosis of sleep disorders &seizures.www.drjayeshpatidar.blogspot.in
  • 7. III. Brain Imaging Tests: Computed Tomography (CT) scan: Measures accuracy ofbrain structure to detect possible lesions, abscesses, areasof infarction or aneurysm. CT scan also identifies variousanatomic differences in patients withschizophrenia, organic mental disorder & bipolar disorder. Magnetic Resonance Imaging (MRI) scan: Measures theanatomic & biochemical status of various segments of thebrain; detects brainedema, ischemia, infection, neoplasm, trauma & otherchanges such as demyelination used in the diagnosis ofdementia, to detect morphological changes inschizophrenia patients.www.drjayeshpatidar.blogspot.in
  • 8. IV. Neuro-endocrine Tests:• Commonly used neuro-endocrine tests aredexamethasone suppression test, TRHstimulation test, serum prolactin levelsserum 17-hydroxycorticosteroid, serummelatonin levels.V. Genetic Tests:• Cytogenetic work-up is advised in somecases of mental retardation.www.drjayeshpatidar.blogspot.in
  • 9. PSYCHOLOGICALTESTS• Psychological testing of patients isidentify conducted by a clinicalpsychologist who has been trained inthe administration, scoring &interpretation of these procedures.www.drjayeshpatidar.blogspot.in
  • 10. Instruments for Assessment ofSymptoms…• Brief psychiatric rating scale• Psychiatric symptoms check list• Clinical global impression• Anxiety self-rating scale• Hamilton anxiety scale• Beck’s anxiety scale• Beck’s depression scale• Hamilton depression scale• Manic state rating scale• Yale brown obsessive compulsive scalewww.drjayeshpatidar.blogspot.in
  • 11. Count…• Suicide intent scale• Nurses observation scale for inpatient evaluation(NOSIE)• Positive & negative symptoms scale (PANSS) forschizophrenia• Extrapyramidal symptoms rating scale• Global assessment of functioning (GAF) scale• Insight & treatment attitude questionnaire (ITAQ)• The CAGE questionnaire• Mini mental status examination (MMSE)• Child behavior check list (CBCL)www.drjayeshpatidar.blogspot.in
  • 12. Instruments for Assessment ofPersonality Traits and Disorders…• Minnesota multiple personalityinventory• Cattel’s 16 factors personality inventory• Eysenck personality inventorywww.drjayeshpatidar.blogspot.in
  • 13. Instruments for Assessment ofCognitive Functioning…• Wechsler adult intelligence scale(WAIS)• Sechsler intelligence scale for children• Binet kamath test of intelligence• Bhatia battery test for intelligence• NIMHANS neuropsychological batteryof lobe dysfunctionwww.drjayeshpatidar.blogspot.in
  • 14. Instruments for Assessment ofEnvironmental Stressors:• Social adjustment scale• Marital satisfaction inventorywww.drjayeshpatidar.blogspot.in
  • 15. Instruments for Assessment ofPsychodynamics:• Rorschach inkblot test• Thematic apperception testwww.drjayeshpatidar.blogspot.in
  • 16. Role of a Nurse in PsychologicalAssessment…Psychological tests have been designed to helpclinicians. They help in:• Measuring the extent of the patient’s problems• Making an accurate diagnosis• Tracking patient progress over time• Documenting the efficacy of treatment Nurses should become familiar with the manystandardized psychological tests that areavailable to enhance each stage of the nursingprocess.www.drjayeshpatidar.blogspot.in
  • 17. Count… These tests help in providing care & measurableindicators for treatment outcome. For example, if the nurse is caring for a patientwith depression, it would be helpful to use one ofthe depression rating scales with the patient atthe beginning of care/treatment to establish abaseline profile of the patient’s symptoms & helpconfirm the diagnosis. The nurse might thenadminister the same scale at various timesduring the course of treatment to measure thepatient’s progress.www.drjayeshpatidar.blogspot.in
  • 18. Count…• A nurse should have knowledge about all thepsychological tests, which will enable her toclarify the patient’s & relative’s doubtsregarding the psychological tests have toundergo.• The nurse should reassure the patient aboutthe safety of the tests & confidentiality of theobservations of the psychologist.• Psychological tests are another source of datafor the nurse to use in planning care for thepatient.www.drjayeshpatidar.blogspot.in
  • 19. www.drjayeshpatidar.blogspot.in