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Mental Health Investigations (Bedside (Communication (Mood assessment…

- - - - Drug screen
      - UTI (delirium)
      - MSU microscopy, culture and sensitivities (infection as a cause of delirium)
    - - Metabolic abnormalities
        
        Self-harm
        
        Eating disorders
  - - - Long QTc - antipsychotics
      - Arrhythmias
    - - Epilepsy (psychosis)
  - - - Depression - anxiety, irritability, low mood can be caused by hypoglycaemia
      - As a cause of delirium
    - - Haemodynamic stability
      - Hypovolaemia
      - Elevated BP in vascular dementia
  - - - ACE III
      - MMSE
    - - Patient Health Questionnaire (PHQ-9)
      - DSM-IV criteria (NICE)
      - Hospital Anxiety and Depression (HAD) scale
- - - - Hypoglycaemia is a common cause of delirium, potentially life-threatening
    - - Antipsychotics can lead to diabetes
      - Hypoglycaemia can cause anxiety/ irritability/ low mood
      - Hypoglycaemia is a risk factor for vascular dementia
    - - Macrocytic anaemias, can compound confusion
      - Low levels mimic dementia
  - - - Risk factor for vascular dementia
      - Side effects of antipsychotics
    - - Acute inflammation
    - - Liver failure/ malnutrition/ alcohol use can all cause confusion/ delirium
      - Baseline drug use and monitoring
      - AST:ALT of 2:1 in alcoholism
    - - Anaemia, raised MCV in alcoholism, infection
    - - Monitor Lithium specifically in Bipolar disorder
      - Baseline drug use and monitoring
      - Deranged electrolytes can cause confusion/ delirium
    - - Warfarin patients - concern about intracranial/ other bleeding
  - - - Calcium
        
        Hypocalcaemia
        
        Increased risk of falls with osteoporosis in the elderly
        
        Hypercalcaemia
        
        Hypercalcaemic can cause confusion/ delirium
        
        psychic moans can mimic depression
  - - - Hypothyroidism as a side effect of Lithium
      - Hypothyroidism - differential in depression
      - Hyperthyroidism - differential in anxiety

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Mental Health Investigations

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