From the Guidelines
For a psychiatric patient, I recommend ordering a comprehensive metabolic panel (CMP), complete blood count (CBC), thyroid function tests (TSH, free T4), vitamin B12, folate, and vitamin D levels as baseline laboratory tests, as supported by the most recent guidelines 1. Additional tests should include fasting blood glucose, lipid panel, and a urine drug screen. If starting medications like lithium or valproic acid, baseline renal and liver function tests are essential, with regular monitoring afterward, as recommended by various studies 1. For patients on antipsychotics, consider ordering an electrocardiogram (ECG) to assess QTc interval and metabolic parameters to monitor for side effects. These tests are important because many medical conditions can mimic psychiatric symptoms, and certain psychiatric medications can affect metabolic parameters, thyroid function, and cardiac conduction, as noted in 1. Substance use can also complicate psychiatric presentations, making toxicology screening valuable. For elderly patients or those with cognitive concerns, adding vitamin B12 and folate levels helps rule out reversible causes of cognitive impairment. The specific panel may need adjustment based on the patient's age, presenting symptoms, medication history, and comorbidities, as suggested by 1.
Some key points to consider when ordering labs for psychiatric patients include:
- Ruling out underlying medical conditions that may be contributing to psychiatric symptoms
- Monitoring for potential side effects of psychiatric medications
- Screening for substance use
- Adjusting the lab panel based on individual patient factors, such as age and comorbidities
- Considering the use of tiered laboratory testing, as recommended by 1, to prioritize tests based on epidemiological and risk/cost-benefit considerations.
It's also important to note that routine testing for certain conditions, such as Lyme disease, is not recommended in psychiatric patients unless clinically indicated, as stated in 1. Overall, a thoughtful and individualized approach to laboratory testing is necessary to ensure that psychiatric patients receive appropriate medical evaluation and treatment.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Laboratory Tests for Psychiatric Patients
The following laboratory tests are recommended for psychiatric patients:
- Complete blood count (CBC) 2, 3
- Comprehensive metabolic panel (CMP) 2, 3
- Urine drug screen (UDS) 2
- Serum ethanol level (EtOH) 2
- Urinalysis (UA) 2, 3
- Creatine kinase (CK) 2
- Urine pregnancy test (UPT) 2
- Rapid COVID-19 test 2
High-Risk Groups
Certain groups of psychiatric patients may require additional laboratory tests, including:
- Patients older than 65 years of age 3
- Patients of low socioeconomic status 3
- State hospital patients 3
- Patients with drug and alcohol histories 2, 3
- Patients with evidence of disorientation, self-neglect, or organic mental disorders 3
- Patients presenting with agitation, abnormal vital signs, intoxication, or a history of or current stimulant use 2
Laboratory Tests with Higher Utility
Certain laboratory tests have been identified as having higher utility for medical intervention in psychiatric patients, including: