Laboratory Studies
The purpose of the workup is to eliminate other possible causes of psychosis, altered mental status, and medical complications. Laboratory evaluation should include the following:
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Complete blood cell count to rule out blood dyscrasias, infection, and anemia
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Basic metabolic panels
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Liver function test: Elevated ratio of alanine aminotransferase (ALT) to aspartate aminotransferase (AST) suggestive of alcohol abuse; elevated ALT and AST-liver failure due to multiple causes; elevated GGT compared with elevated liver enzymes has higher specificity for alcohol dependency
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Urinalysis to determine the presence of a urinary tract infection and determine renal function
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Stat urine or serum drug screen to determine if illicit drugs are contributing to psychosis and change in mental status
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Stat urine or serum toxicology screen for levels of acetaminophen, tricyclic antidepressants, aspirin, and other potential toxins from either an accidental or deliberate overdose
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Prothrombin time
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Stool for occult blood
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BAL measurement (although a patient may appear intoxicated, clinical intoxication can be determined only by BAL)
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Thyroid-stimulating hormone (TSH)
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Vitamin B-12/folate
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Rapid plasma reagin (RPR)
Imaging Studies
If a head injury is suspected, a CT scan is recommended to rule out a subdural hematoma.
In those with comorbid schizophrenia and alcoholism, MRIs have shown that the gray matter volume deficits in the prefrontal and anterior superior temporal regions is greater than in those with schizophrenia and alcoholism alone.
Chest radiography can be considered for all homeless patients, elderly patients, and patients with risk factors for tuberculosis.
Other Tests
Some other tests that might be administered include a Brief Psychotic Rating Scale (BPRS), Beck Depression Scale, Violence and Suicide Assessment (VASA), and Mini-Mental State Examination. Other measures also might be useful.
If persistent psychosis is noted, neuropsychological testing to assess the level of psychosocial and neurological function can be beneficial for treatment and placement.
Projective testing, such as the Rorschach and the Thematic Apperception Test, can clarify a thought disorder.
