This document discusses various investigations and psychological tests used in psychiatry. It categorizes investigations into routine tests, electrophysiological tests, brain imaging tests, neuroendocrine tests, and genetic tests. Some key routine tests mentioned include complete blood count, urine analysis, renal and liver function tests, electrolytes, and drug level estimation. Psychological tests are used to assess symptoms, personality, cognitive functioning, environmental stressors, and psychodynamics. Nurses should be familiar with psychological tests to enhance treatment and measure patient progress.

1. INVESTIGATION
IN
PSYCHIATRY
MR. JAYESH PATIDAR
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2. INTRODUCTION…
• Investigation are useful to detect alteration
in biologic function & to screen for medical
disorders causing psychiatric symptoms.
• Classification of investigation:
I. Routine Investigation
II. Electrophysiological Tests
III. Brain Imaging Tests
IV. Neuro-endocrine Tests
V. Genetic Tests
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3. I. Routine Investigation:
• A complete hemogram (total & differential blood
count, hemoglobin, 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 &
benzodiazepines.
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4. Count…
• 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, dementia.
• VDRL: Suggestive sexual history
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5. Count…
• Serum CPK: Neuroleptic malignant syndrome
(markedly increased levels)
• 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 (6-12
mg/ml, valproate (50-100 mg/ml), haloperidol (8-
18 mg/ml), imipramine (200-250mg/ml), etc)
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6. II. Electrophysiological Tests:
• Electroencephalogram (EEG): Measures
brain electrical activity, identifies
dysrhythmias & asymmetric, used in the
diagnosis of
seizures, dementia, neoplasm, stroke, m
etabolic or degenerative disease.
• Polysomnography/sleep studies: Used in
the diagnosis of sleep disorders &
seizures.
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7. 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.
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8. IV. Neuro-endocrine Tests:
• Commonly used neuro-endocrine tests are
dexamethasone suppression test, TRH
stimulation test, serum prolactin levels
serum 17-hydroxycorticosteroid, serum
melatonin levels.
V. Genetic Tests:
• Cytogenetic work-up is advised in some
cases of mental retardation.
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9. PSYCHOLOGICAL
TESTS
• Psychological testing of patients is
identify conducted by a clinical
psychologist who has been trained in
the administration, scoring &
interpretation of these procedures.
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10. Instruments for Assessment of
Symptoms…
• 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 scale
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11. Count…
• Suicide intent scale
• Nurses observation scale for inpatient evaluation
(NOSIE)
• Positive & negative symptoms scale (PANSS) for
schizophrenia
• 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)
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12. Instruments for Assessment of
Personality Traits and Disorders…
• Minnesota multiple personality
inventory
• Cattel’s 16 factors personality inventory
• Eysenck personality inventory
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13. Instruments for Assessment of
Cognitive Functioning…
• Wechsler adult intelligence scale
(WAIS)
• Sechsler intelligence scale for children
• Binet kamath test of intelligence
• Bhatia battery test for intelligence
• NIMHANS neuropsychological battery
of lobe dysfunction
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14. Instruments for Assessment of
Environmental Stressors:
• Social adjustment scale
• Marital satisfaction inventory
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15. Instruments for Assessment of
Psychodynamics:
• Rorschach inkblot test
• Thematic apperception test
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16. Role of a Nurse in Psychological
Assessment…
Psychological tests have been designed to help
clinicians. 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 many
standardized psychological tests that are
available to enhance each stage of the nursing
process.
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17. Count…
 These tests help in providing care & measurable
indicators for treatment outcome.
 For example, if the nurse is caring for a patient
with depression, it would be helpful to use one of
the depression rating scales with the patient at
the beginning of care/treatment to establish a
baseline profile of the patient’s symptoms & help
confirm the diagnosis. The nurse might then
administer the same scale at various times
during the course of treatment to measure the
patient’s progress.
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18. Count…
• A nurse should have knowledge about all the
psychological tests, which will enable her to
clarify the patient’s & relative’s doubts
regarding the psychological tests have to
undergo.
• The nurse should reassure the patient about
the safety of the tests & confidentiality of the
observations of the psychologist.
• Psychological tests are another source of data
for the nurse to use in planning care for the
patient.
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