Wednesday, August 6, 2008

Bipolar Disorder: Psychiatric and Medical Evaluation

Handbook of Emergency Psychiatry [2007 edition]

Psychiatric Evaluation
[p.p. 164-65]

As part of the initial evaluation of the patient with bipolar disorder, the clinician should:
- Observe behavior and affect
- Obtain a detailed medical history, including any medical problems and any medications
- Ask about recent mood swings and their duration
- Ask about family medical history, particularly whether anyone has or had bipolar disorder
- Ask family members (after obtaining authorization of information release) for information that can complement the history

Medical Evaluation [p. 165]

Patients with newly diagnosed bipolar disorder require a medical evaluation as well as a psychiatric evaluation. The following assessment is recommended.
- Complete physical examination
- Serum levels of lithium, valproic acid, carbamazepine and other selected medications (if relevant)
- Thyroid function tests
- Complete blood count (CBC) and general chemistry screening
- Urinalysis if lithium therapy is initiated
- Pregnancy test (if relevant)
- Urine toxicology for substance abuse

Oxford Handbook of Psychiatry [2006 Edition]

Investigations As for depression; full physical and routine blood tests to exclude any treatable cause, including FBC, ESR, glucose, U&Es, CA2+, TFTs, LFTs, drug screen. Less routine tests: urinary copper (to exclude Wilson's disease [rare], ANF (SLE), infection screen (VDRL, HIV test). CT/MRI brain (to exclude tumour, infarction, haemorrhage, MS) - may show hyperintense subcortical structures (esp temporal lobes), ventricular enlargement and sulcal prominence; EEG (baseline and to rule out epilepsy). Other baseline tests prior to treatment should include ECG and creatinine clearance. [p. 310]