Depression labs?

[i61164]

So I am supposed to find the answer to the following in my psych text:

Describe the common laboratory assessments used in patients presenting with possible depression.

I think the answer is "there are none," because the diagnosis is phenomenologic but that would be too easy and I think they are going to ask a quiz question about this tomorrow in class. The only thing I could find in the chapter was:

-neuropsychological tests
-Beck depression inventory
-Zung self-rating depression scale
-Inventory for depressive symptomatology
-Hamilton Depression rating scale
-Montgomery-Asberg Depression rating scale

These could be the answers they are looking for, but when I think of laboratory, I am usually thinking about things like blood work. What do you guys think?

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[Milo]

Just to get the ball rolling...

TSH

 

[MBK2003]

RPR
Vitamin B12

 

[PublicHealth]

Have a look here (especially the section on "Lab Studies"): http://www.emedicine.com/MED/topic532.htm

Note that, "No diagnostic laboratory tests are available for diagnosis of MDD."

 

[i61164]

Well, I took the quiz this morning and the question was:

Which would be the least useful for the clinical evaluation of a patient with possible depression?

A) Question about substance abuse
B) Question about current meds
C) Neurovegetative signs
D) Question about suicidal thoughts
E) Dexamethasone suppression testing

The right answer is E. They told us that dexamethasone suppression testing has a really low sensitivity so it would fairly useless. I guess it would have made more sense if they told us to know which lab tests aren't useful.

 

[Anasazi23]

I had the dexamethasone supression test in mind when you asked the question. I had a feeling they were gearing up for that. Years ago, you could pay a lot of money at a private hospital to have this test performed to see if you had depression, or were prone to it. It didn't last long, as it was determined that the sensitivity was low, and had confounding factors.

Routine labs, other than TSH, and perhaps a BMP, are not routinely run for depression. Depending on the presenting symptoms (i.e. memory impairment, neurovegetative signs, etc) you might run individual tests to eliminate reasonable diagnostic possibilities if your clinical impression warrants it.

A good clinical interview is impossible to beat, if you are well-versed in descriptive psychopathology and its subtleties. Better even than psychological testing, I would argue. Structured psychological tests leave out a large amount of descriptive pathology, and give no adherence to the patient's objective presentation - which is often the most important part of the clinical puzzle.

 

[Psyclops]

Ana, not arguing with you, but it's imortant to remember that psychological tests aren't (or at least shouldn't) be given blind, they are merely an additional tool, to be interpreted by a clinicain, ultimately as you mention the clinical impression is what counts. Just picking the nits.

 

[Milo]

Just picking the nits.

ewwww, gross. Psychologists do that? Now I know why y'all want RxP, for the permethrin.

 

[i61164]

Routine labs, other than TSH, and perhaps a BMP, are not routinely run for depression.

What about CBC? Can a patient leave the hospital without getting one? I heard that mean corpuscular volume can be elevated in alcoholics so it's a sneaky way to find out without doing BAC or Tox screen. Do "routine" tests vary between inpatient and outpatient?

 

[Anasazi23]

What about CBC? Can a patient leave the hospital without getting one? I heard that mean corpuscular volume can be elevated in alcoholics so it's a sneaky way to find out without doing BAC or Tox screen. Do "routine" tests vary between inpatient and outpatient?

It does vary between inpatient and outpatient. While the scope of all things medical that can manifest psychiatrically is way beyond the scope of a post (or forum), psychiatrists routinely do more extensive lab work for inpatients than outpatients in general.

There are a few ways to determine if someone is likely an alcoholic. MCV is one. Just like there are back-door ways to seeing if someone likely has HIV without them consenting to an HIV test.

In my inpatient hospital, we do BMP, CBC, MG, Phos, U-tox, Lipids, UA, EKG, TFTs, and RPR if it's clinically warranted, and LFTs. Of course, we order more tests depending on the presentation (first break, and labs for comorbid medical conditions). Depending on the patient, we may order neuroimaging or even x-rays of the chest/abd.

There are APA guidelines that suggest you have on file lab tests germaine to the medications you are giving, particularly antipsychotics, in an outpatient setting. Most important usually include those whose organ systems are affected by meds i.e. renal, TFTs - Li, LFTs for a variety of meds, and cholesterol/lipids in antipsychotics. BMI calculations, weights, vitals, and abdominal circumference are other simple, common ones.

 

[Solideliquid]

It does vary between inpatient and outpatient. While the scope of all things medical that can manifest psychiatrically is way beyond the scope of a post (or forum), psychiatrists routinely do more extensive lab work for inpatients than outpatients in general.

There are a few ways to determine if someone is likely an alcoholic. MCV is one. Just like there are back-door ways to seeing if someone likely has HIV without them consenting to an HIV test.

In my inpatient hospital, we do BMP, CBC, MG, Phos, U-tox, Lipids, UA, EKG, TFTs, and RPR if it's clinically warranted, and LFTs. Of course, we order more tests depending on the presentation (first break, and labs for comorbid medical conditions). Depending on the patient, we may order neuroimaging or even x-rays of the chest/abd.

There are APA guidelines that suggest you have on file lab tests germaine to the medications you are giving, particularly antipsychotics, in an outpatient setting. Most important usually include those whose organ systems are affected by meds i.e. renal, TFTs - Li, LFTs for a variety of meds, and cholesterol/lipids in antipsychotics. BMI calculations, weights, vitals, and abdominal circumference are other simple, common ones.

Um, such as?

 

[Miklos]

Um, such as?

I'm curious as well. Apart from a CD4 count?

 

[Miklos]

What about CBC?

What about a CBC for anemia?

 

[Anasazi23]

Um, such as?

CD4, granulocytopenia, oral or urine immunoassay, (+) c.diff, fungal culture, etc.

Not confirmatory measures, but helps in certain situations.

Imagine you get needle-stuck by a suspicious-looking patient and the they refuse an HIV and Hep C test....

Speaking of needlestick...I have to go put in an IV for ect.