Investigation in psychiatry


Published on

Published in: Health & Medicine
No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Investigation in psychiatry

  2. 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
  3. 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 &
  4. 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
  5. 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)
  6. 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 &
  7. 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
  8. 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
  9. 9. PSYCHOLOGICALTESTS• Psychological testing of patients isidentify conducted by a clinicalpsychologist who has been trained inthe administration, scoring &interpretation of these
  10. 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
  11. 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)
  12. 12. Instruments for Assessment ofPersonality Traits and Disorders…• Minnesota multiple personalityinventory• Cattel’s 16 factors personality inventory• Eysenck personality
  13. 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
  14. 14. Instruments for Assessment ofEnvironmental Stressors:• Social adjustment scale• Marital satisfaction
  15. 15. Instruments for Assessment ofPsychodynamics:• Rorschach inkblot test• Thematic apperception
  16. 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
  17. 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
  18. 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
  19. 19.