Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-31T15:04:49.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Benefits and Problems of Routine Laboratory Investigations in Adult Psychiatric Admissions

Published online by Cambridge University Press:  02 January 2018

Anthony J. White  and
Brian Barraclough
Anthony J. White*
Affiliation:
Royal South Hants Hospital, Graham Road, Southampton, currently Bristol General Hospital
Brian Barraclough
Affiliation:
University Department of Psychiatry, Royal South Hants Hospital, Graham Road, Southampton S09 4PE
*
∗Bristol General Hospital, Guinea Street, Bristol BS1 6SY
Get access Rights & Permissions [Opens in a new window]

Abstract

A survey of laboratory investigations in the management of 1007 non-geriatric admissions to a district general hospital adult psychiatric unit showed a wide variation in the number of tests performed, and in the abnormal proportion between test types. Despite a policy of screening on admission, 40% of admissions had no tests. Physical illness attributable to mental illness was common, but rarely serious and usually apparent clinically. Mental illness attributable to physical illness detected by laboratory tests was rare: five cases of thyroid disease in women with affective disorder, and two cases of chest infection with raised white cell count in sustained mania. The findings show that tests are frequently used in circumstances where the result is of no apparent value. Test use might be improved by restricting screening to thyroid function and laboratory urine analysis, each in women. There are particular indications for white cell count in sustained or unexplained relapse of mental illness, and for syphilis serology when disinhibition may have exposed the patient to infection.

Type
Papers
Information
The British Journal of Psychiatry , Volume 155 , Issue 1 , July 1989 , pp. 65 - 72
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ashley, J. S. A., Pasker, P. & Beresford, J. C. (1972) How much clinical investigation? Lancet, i, 890–892.Google Scholar
Bannister, P., Mortimer, A., Shapiro, L., et al (1987) Thyroid function screening of psychiatric inpatient admissions: a worthwhile procedure? Journal of the Royal Society of Medicine, 80, 77–78.Google Scholar
Bradwell, A. R., Carmalt, M. H. B. & Whitehead, T. D. (1974) Explaining the unexpected abnormal results of biochemical profile investigation. Lancet, ii, 1071–1074.Google Scholar
Cohen, D. I., Jones, B. & Neuhauser, D. (1982) Does cost information availability reduce physician test usage? Medical Care, 20, 286–292.Google Scholar
Cumming, A. D., Farquhar, J. R. & Boucher, I. A. D. (1987) Refeeding hypophosphataemia in anorexia nervosa and alcoholism. British Medical Journal, 295, 490–491.CrossRefGoogle ScholarPubMed
Dacie, J. V. & Lewis, S. M. (1975) Practical Haematology (5th edn). Edinburgh: Churchill Livingstone.Google Scholar
Daniels, M. & Schroeder, S. A. (1977) Variation among physicians in use of laboratory tests. Medical Care, 15, 482–487.Google Scholar
Eastwood, M. R. & Trevelyan, M. H. (1972) Relationship between physical and psychiatric disorder. Psychological Medicine, 2, 363–372.Google Scholar
Everett, G., de Blois, S., Chang, P. F., et al (1983) Effects of cost education, cost audits and faculty chart review on the use of laboratory services. Archives of Internal Medicine, 143, 942–944.Google Scholar
Ferguson, B. & Dudleston, K. (1986) Detection of physical disorder in newly admitted psychiatric patients. Acta Psychiatrica Scandinavica, 74, 485–489.Google Scholar
Fleming, P. R. & Zilva, J. F. (1981) Workloads in clinical pathology: too many tests? Health Trends, 13, 46–49.Google Scholar
Forrest, J. B., Ritchie, W. P., Hudson, M., et al (1981) Cost containment through cost awareness. Surgery, 90, 154–158.Google Scholar
Forrest, R. D., Jackson, C. A. & Yudkin, J. S. (1987) The epidemiology of the haemoglobin level – a study of 1057 subjects in general practice. Postgraduate Medical Journal, 63, 625–628.Google Scholar
Fowkes, F. G. R. (1985) Containing the use of diagnostic tests. British Medical Journal, 290, 488–489.CrossRefGoogle ScholarPubMed
Fowkes, F. G. R., Davies, E. R., Evans, K. T., et al (1986) Multicentre trial of 4 strategies to reduce the use of a radiological test. Lancet, i, 367–370.Google Scholar
Gooch, B. R., Isley, W. L. & Utiger, R. D. (1982) Abnormalities in thyroid function tests in patients admitted to a medical service. Archives of Internal Medicine, 142, 1801–1805.Google Scholar
Griner, P. F. & Glaser, R. J. (1982) Misuse of laboratory diagnostic procedures. New England Journal of Medicine, 307, 1336–1339.Google Scholar
Hall, R. C. W., Popkin, M. K., Devaul, R. A., et al (1978) Unrecognised physical illness prompting psychiatric admission: a prospective study. Archives of General Psychiatry, 35, 1315–1320.Google Scholar
Hall, R. C. W., Gardner, E. R., Popkin, M. K., et al (1981) Unrecognised physical illness prompting psychiatric admission: a prospective study. American Journal of Psychiatry, 138, 629–635.Google Scholar
Hamblin, T. J. (1983) Blood counts and economics. British Medical Journal, 286, 1918–1919.Google Scholar
Hampton, J. R., Harrison, M. J. G., Mitchell, J. R. A., et al (1975) Relative contributions of history taking, physical examination and laboratory investigations to diagnosis and management of medical outpatients. British Medical Journal, ii, 486–489.Google Scholar
Hampton, J. R. (1983) The end of clinical freedom. British Medical Journal, 287, 1237–1238.Google Scholar
Hart, G. (1986) Syphilis tests in diagnostic and therapeutic decision making. Annals of Internal Medicine, 104, 368–376.Google Scholar
Hartley, R. M., Charlton, J. R., Harris, C. M., et al (1984) Influence of patient characteristics on test ordering in general practice. British Medical Journal, 289, 735–738.Google Scholar
Hecker, R. (1975) Medical practice and multiphasic screening. Medical Journal of Australia, 2, 398–401.Google Scholar
Herridge, C. F. (1970) Physical disorders in psychiatric illness. Lancet, ii, 949–951.Google Scholar
Hinkle, L. E., & Wolff, H. G. (1957) The nature of man's adaption to his total environment and the relation of this to illness. Archives of Internal Medicine, 99, 442–460.Google Scholar
Hodkinson, H. M. (1981) Value of admission profile tests for prognosis in elderly patients. Journal of the American Geriatrics Society, 39, 206–210.Google Scholar
Howell, R. W. (1970) Smoking habits and laboratory tests. Lancet, ii, 152.Google Scholar
Kaplan, E. B., Scheiner, L. B. & Boeckmann, A. J. (1985) The usefulness of preoperative laboratory screening. Journal of the American Medical Association, 253, 3576–3581.CrossRefGoogle ScholarPubMed
Knight, B. (1986) Problems in laboratory medicine. Medical Protection Society Annual Report, 94, 31–32.Google Scholar
Lancet (1979) Psychiatrists with blinkers. Lancet, ii, 81.Google Scholar
Lancet (1987) Depression, stress and immunity. Lancet, ii, 1467–1468.Google Scholar
Latchman, R. W. (1986) Gammaglutamyl transpeptidase and mean corpuscular volume in the assessment of inpatient alcoholics. British Journal of Psychiatry, 149, 353–356.Google Scholar
Leonard, J. V., Clayton, B. E. & Colley, J. R. T. (1975) Use of biochemical profiles in a children's hospital: results of 2 controlled trials. British Medical Journal, ii, 662–665.CrossRefGoogle Scholar
Lloyd, G. G. (1977) Psychological reactions to physical illness. British Journal of Hospital Medicine, 18, 352–358.Google Scholar
Maguire, G. P. & Granville-Grossman, K. L. (1968) Physical illness in psychiatric patients. British Journal of Psychiatry, 114, 1365–1369.Google Scholar
Mills, K. A. & Reilly, P. M. (1983) Laboratory and radiological investigations in general practice. British Medical Journal, 287, 1265–1268.CrossRefGoogle ScholarPubMed
Moloney, T. W. & Rogers, D. E. (1979) Medical technology – a different view of the contentious debate over costs. New England Journal of Medicine, 301, 1413–1419.Google Scholar
Mooney, G. H. & Drummond, M. F. (1982) Essentials of health economics. British Medical Journal, 285, 949–950.Google Scholar
Murphy, D. L., Goodwin, F. K. & Bunne, W. E. (1971) Leukocytosis during lithium treatment. American Journal of Psychiatry, 127, 1559.Google Scholar
Reuben, D. B. (1984) Learning diagnostic restraint. New England Journal of Medicine, 310, 591–593.Google Scholar
Ritz, E. (1982) Acute hypophosphataemia. Kidney International, 22, 84–94.Google Scholar
Sackett, D. L. (1973) The usefulness of laboratory tests in health screening programs. Clinical Chemistry, 19, 366–372.CrossRefGoogle ScholarPubMed
Schroeder, S. A. & Showstack, J. A. (1978) Financial incentives to perform medical procedures and laboratory tests. Medical Care, 16, 289–298.Google Scholar
Skinner, H. A., Holt, S., Sheu, W. J., et al (1986) Clinical versus laboratory detection of alcohol abuse: the alcohol clinical index. British Medical Journal, 292, 1703–1708.Google Scholar
Sox, H. C., Margulies, I. & Sox, C. H. (1981) Psychologically mediated effects of diagnostic tests. Annals of Internal Medicine, 95, 680–685.Google Scholar
Sox, H. C. & Liang, M. H. (1986) Erythrocyte sedimentation rate-guidelines for rational use. Annals of Internal Medicine, 104, 515–523.Google Scholar
Tarbit, I. F. (1986) Costing clinical biochemistry services as part of an operational management budgeting system. Journal of Clinical Pathology, 39, 817–827.CrossRefGoogle ScholarPubMed
Thomas, C. J. (1979) The use of screening investigations in psychiatry. British Journal of Psychiatry, 135, 65–72.Google Scholar
Thurow, L. C. (1985) Medicine versus economics. New England Journal of Medicine, 313, 611–614.Google Scholar
White, A. J. & Barraclough, B. (1986) Radiology for psychiatric patients? British Medical Journal, 292, 800–801.Google Scholar
White, A. J. & Barraclough, B. (1988) Thyroid disease and mental illness. Journal of Psychosomatic Research, 32, 99–106.Google Scholar
Whitehead, T. P. & Wootton, I. D. P. (1974) Biochemical profiles for hospital patients. Lancet, ii, 1439–1440.Google Scholar
Willett, A. B. & King, T. (1977) Implementation of laboratory screening procedures on a short term psychiatric inpatient unit. Diseases of the Nervous System, 38, 867–870.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.