Mental Health Investigations

Bedside

Fluids

Machines

Physiological

Urine

Drug screen

ECG

Long QTc - antipsychotics

BM

Depression - anxiety, irritability, low mood can be caused by hypoglycaemia

Arrhythmias

UTI (delirium)

MSU microscopy, culture and sensitivities (infection as a cause of delirium)

Basic observations

Communication

Collateral history

Haemodynamic stability

Hypovolaemia

Elevated BP in vascular dementia

Cognitive assessment

ACE III

EEG

Epilepsy (psychosis)

Mood assessment

Patient Health Questionnaire (PHQ-9)

DSM-IV criteria (NICE)

Hospital Anxiety and Depression (HAD) scale

ABG

Metabolic abnormalities

Self-harm

Eating disorders

MMSE

Bloods

Other

Blood glucose

Hypoglycaemia is a common cause of delirium, potentially life-threatening

HbA1c

Antipsychotics can lead to diabetes

Hypoglycaemia can cause anxiety/ irritability/ low mood

Hypoglycaemia is a risk factor for vascular dementia

B12/ folate

Macrocytic anaemias, can compound confusion

Low levels mimic dementia

Circulatory

Lipid screen

Risk factor for vascular dementia

Side effects of antipsychotics

CRP

Acute inflammation

LFT

Liver failure/ malnutrition/ alcohol use can all cause confusion/ delirium

Baseline drug use and monitoring

AST:ALT of 2:1 in alcoholism

FBC

Anaemia, raised MCV in alcoholism, infection

U/E

Monitor Lithium specifically in Bipolar disorder

Baseline drug use and monitoring

Deranged electrolytes can cause confusion/ delirium

INR

Warfarin patients - concern about intracranial/ other bleeding

Ions

Bone Profile

Calcium

Hypocalcaemia

Hypercalcaemia

Hypercalcaemic can cause confusion/ delirium

Hormones

TFT

Hypothyroidism as a side effect of Lithium

Hypothyroidism - differential in depression

Hyperthyroidism - differential in anxiety

psychic moans can mimic depression

Increased risk of falls with osteoporosis in the elderly

Imaging

MRI

CXR

CT

As a cause of delirium

Infection causing delirium

Vascular dementia/ SOL

Vascular dementia/ SOL