Physical investigations

The aim of physical investigation is to find a treatable lesion and/or make an aetiological diagnosis. 'Routine' laboratory tests seldom yield abnormal results in young adult psychiatric patients, unless there are physical symptoms or signs, or a history of alcohol misuse. Therefore, screening of younger patients who appear to be in good physical health is clearly not cost-effective, although many units do carry out blood tests on all new admissions, and these reveal occasional cases of unsuspected organic disease, most commonly thyroid dysfunction in women.

Elderly patients, and patients of any age with symptoms or signs suggesting physical illness, do need investigation. Basic tests include blood count and eryth-

rocyte sedimentation rate (ESR); urea and electrolytes; thyroid and liver function; vitamin Bi2 and folate; urine testing for glucose, protein, cells, and bacteria; and chest radiography (but skull radiography very seldom yields useful information). Other tests such as the electroencephalogram (EEG), brain scan, analysis of blood or urine for drugs, syphilis serology, and HIV testing may be done if clinical indications exist. (Except in very special circumstances, HIV testing should not be carried out unless the patient gives informed consent, and receives both pre- and post-test counselling.)

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