Psychiatry - H.T. Sonnyk 2003

Methods of psychiatric patient examination
Laboratory tests

Diagnostic laboratory tests in psychiatry serve a dual purpose: on the one hand, they assess the somatic status of patients at various Stages of the diagnostic and Treatment process, and on the other, they help detect somatic pathology caused by underlying psychoses.

Routine Blood and urine tests are particularly valuable for diagnosing infectious or other concurrent diseases, given that psychiatric patients are less likely to report a general decline in their physical health.

Additionally, the febrile form of Schizophrenia is typically characterized by an increased specific gravity of urine, leukocytosis, elevated ESR, and toxic granulation of neutrophils. Chronic schizophrenia, meanwhile, is frequently accompanied by lymphocytosis.

Protein and glucose in the urine, alongside a leukocyte blood reaction, are characteristic findings in patients with Epilepsy immediately following a seizure.

It is well established that certain psychotropic medications can lead to adverse hematological and renal complications (e.g., clozapine and melipramine may cause agranulocytosis, while prolonged treatment with haloperidol can induce lymphomonocytosis).

Ongoing monitoring of renal function is also essential for the early detection of subclinical or insidious Kidney damage, as such conditions may contraindicate treatment with psychotropic agents and Insulin.

Biochemical blood and urine analyses are frequently utilized in psychiatric practice. Blood glucose testing is appropriate for detecting cannabinoid intoxication (manifesting as hypoglycemia) or during insulin therapy for psychoses, among other Applications. Determining the prothrombin index is advisable during prolonged treatment with aminazine due to the heightened risk of thromboembolic disease.

Lithium therapy for affective psychoses requires regular monitoring of blood lithium levels (initially once a month, and subsequently every 2–3 months). The normal therapeutic concentration ranges from 0.6 to 1.2 mEq/L.

CEREBROSPINAL FLUID (CSF) analysis is prescribed when organic Brain disease is suspected. A lumbar puncture is performed only with the informed consent of the patient or their relatives (if the patient is unconscious or suffering from a severe psychiatric disorder). The Procedure is carried out by a physician using a specialized needle with a stylet, which is inserted into the terminal cistern of the Spinal Cord between the III and IV or IV and V lumbar vertebrae while the patient is in a sitting or lateral recumbent position. For analysis, 4–8 mL of CSF is collected. The flow rate of the fluid provides an indication of intracranial pressure. The presence of blood in the CSF may result from minor vessel trauma during the puncture, whereas a uniformly red discoloration of the cerebrospinal fluid is characteristic of arachnoid and cerebral hemorrhages. Following the puncture, the patient must observe strict bed rest for 2–3 hours.

The normal Cell count in the CSF is 3–5 Cells per 1 µL of fluid. An elevation in cell count (pleocytosis) occurs in acute Purulent meningitis, encephalitis, and Brain Tumors. The normal protein content ranges from 0.15 to 0.3 g/L and increases during inflammatory processes and neoplastic diseases. In the case of brain tumors, a characteristic "protein-cell dissociation" is observed, where protein levels increase tenfold or more while pleocytosis remains minimal.

Colloidal and precipitation tests of the CSF—such as the Nonne-Apelt, Pandy, and Lange reactions—are informative for cerebral organic pathology and typically yield positive results. To diagnose syphilitic brain lesions, serological tests (such as the Wassermann, Kahn, and Sachs-Witebsky reactions) are performed using the CSF.

Immunological studies. A comprehensive immunological evaluation assesses factors of non-specific systemic reactivity, including heterophilic hemolysins, hemagglutinins, The Complement System, and non-specific immunoglobulin levels, as well as autoantigens and autoantibodies to brain Antigens in the patient's blood, and indicators of neuroallergic reactions.

Impairments in immune system functioning highlight The Need for pathogenetically substantiated psycho-immunorehabilitation for these patients.