UNZA Pharmacy Training Lecture notes

1. Biological Assessment of patients with
Psychiatric Symptoms
Dr. Naeem Dalal
Department of Psychiatry
University of Zambia, School Of Medicine

2. Outline
Introduction
Biopsychosocial Model
History Taking
Investigations
Baseline /Routine Tests
Electrophysiological Tests
Brain Imaging Tests
Rule out other diagnosis
Follow up

3. Introduction
The assessment of patients with mental health problems is
often seen as very different from assessment in other areas
of medicine.
However, it actually has much in common with any area of
medicine in which taking a good history is vital.
It should be conducted in a systematic way using good
interview techniques.

4. A clear knowledge of signs of mental illness (e.g. delusions,
hallucinations) is essential for an accurate assessment of a
patient's difficulties.
This should allow the clinician to reach a differential
diagnosis, and to estimate how much confidence can be
placed in the primary diagnosis.

5. Although there are few diagnostic tests in psychiatry,
appropriate investigation of patients includes an
assessment of their physical health (and whether this
might relate to their psychiatric presentation), a formal
and detailed assessment of their cognitive function
(which can help characterize or localize possible brain
pathology), objective ratings of the severity of
symptoms, and neuroimaging

7. History Taking

8. Investigations
Investigation are useful to detect alteration in biologic
function and to screen for medical disorders causing
psychiatric symptoms.
Classification of investigation:
I. Routine Investigation
II. Electrophysiological Tests
III. Brain Imaging Tests
IV. Genetic Tests

9. I Baseline/Routine
A complete haemogram (total & differential blood count,
haemoglobin, ESR)
Urine analysis are basic routine tests.
Leucopenia & agranulocytosis are associated with certain
medications (clozapine).
Treatment with lithium & neuroleptic malignant syndrome
are often associated with leucocytosis.
Renal function tests: Treatment with lithium.
Liver function tests: For all alcoholic patients treatment
with carbamazepine, valproate and benzodiazepines

10. Routine
Serum electrolytes: Dehydration, treatment with
carbamazepine, antipsychotics, lithium
Blood glucose: Routine screen above 35 years age
Thyroid function test: Depression, treatment with
lithium & carbamazepine.
Electrocardiogram (ECG): Above 35 years of age,
treatment with lithium, antidepressants, ECT,
antipsychotics.
HIV testing: IV drug users, suggestive sexual history,
AIDS, STD

11. II. Electrophysiological Tests
Electroencephalogram (EEG): Measures brain
electrical activity, identifies dysrhythmias &
asymmetric, used in the diagnosis of seizures,
dementia, neoplasm, stroke, metabolic or
degenerative disease.
Polysomnography/sleep studies: Used in the
diagnosis of sleep disorders &seizures

12. III. Brain Imaging Tests
Computed Tomography (CT) scan: Measures
accuracy of brain structure to detect possible lesions,
abscesses, areas of infarction or aneurysm. CT scan also
identifies various anatomic differences in patients with
schizophrenia, organic mental disorder & bipolar
disorder.
Magnetic Resonance Imaging (MRI) scan: Measures
the anatomic & biochemical status of various segments
of the brain; detects brain edema, ischemia, infection,
neoplasm, trauma & other changes such as
demyelination used in the diagnosis of dementia, to
detect morphological changes in schizophrenia patients

13. IV. Genetic Tests
Cytogenetic work-up is advised in some cases of
learning disabilities

14. Additional Tests
Chest X-ray: Before treatment with ECT
Drug level estimation: Drug levels are indicated to
test for therapeutic blood levels, for toxic blood
levels & for testing drug compliance.
Examples are 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)

15. Rule out other diagnosis
Infections: HIV-AIDS, RPR
Substance Use Disorder: Urine Drug Toxicology
or Blood Toxicology

16. Follow up
Dependant on specific patient population.

17. Psychiatric Pharmacists
Psychiatric illnesses tend to be chronic and challenge
patients throughout their lifetimes.
Consequently, psychiatric pharmacists serve populations
from youths to older adults.
Psychiatric pharmacists often find themselves serving
people in areas such as:
- chemical dependency,
- developmental disabilities,
- long-term care facilities,
- adherence clinics,
- mental health clinics, and within the prison systems.