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Chapter 10. Use of the Laboratory in the Diagnostic Workup of Older Adults

Mugdha Thakur, M.D.; P. Murali Doraiswamy, M.D.
DOI: 10.1176/appi.books.9781585623754.389827

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Excerpt

Laboratory testing is an essential component of the psychiatric evaluation of elderly individuals, who often present with comorbid medical illnesses. The laboratory does not replace the clinician; there is no test that is pathognomonic for a primary psychiatric illness. However, laboratory testing does aid in the evaluation of comorbidities that complicate or contribute to a psychiatric diagnosis.

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Table Reference Number
Table 10–1. Guidelines for screening and monitoring of patients started on second-generation antipsychotic agentsa
Table Reference Number
Table 10–2. Patterns of thyroid function tests
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Table 10–3. Common electrocardiographic abnormalities associated with psychotropic medications
Table Reference Number
Table 10–4. Neuroimaging in geriatric psychiatry

References

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Sample questions:
1.
You are treating an 83-year-old patient for depression and she develops fatigue, nausea, dizziness, gait disturbances, forgetfulness, confusion, lethargy, and muscle cramps. You obtain a general chemistry panel, and her serum sodium concentration is 120 mEq/L. What psychotropic medication has been reported to produce this condition in the elderly?
2.
You are asked to evaluate a 79-year-old man who was hospitalized on the general medical service for evaluation of mental status changes associated with malnutrition. You recommend to the medical team that they order a serum homocysteine level. The resident asks why the order is necessary. All of the following answers are true except
3.
In a community psychiatry clinic, you see for the first time a 78-year-old patient who has been treated for a number of years with thioridazine. You immediately decide to order an electrocardiogram (ECG). What ECG changes are you particularly concerned about?
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