Investigations
It is important to rule-out organic causes before assuming that a patient has a psychiatric condition, particularly if this is their first presentation.
- Bloods
- FBC with B12, folate and iron studies
- CRP
- U&E
- LFT
- TFTs
- Ca/Mg/PO4
- Drug Levels:
- Lithium levels: important if you suspect non-compliance or toxicity. Should be taken 12-hours after the dose.
- Digoxin levels: Dig toxicity is a cause of delerium
- General health check:
- HbA1c,
- Cholesterol and lipid screen
- Urine: drug screen +/- pregnancy test +/- MSU
- ECG: many psychotropic medications will affect the QT interval
- CT Brain may be appropriate to check for organic causes e.g. a first episode of psychosis or confusion, which could be due to a space-occupying lesion or intracranial bleed
- If considering delirium, you should do a septic screen including
- Routine bloods (FBC, UEC, LFT, CRP)
- Blood Cultures
- CXR
- MSU