Leonard Lachover, MD Clinical assistant professor, department of psychiatry and behavioral sciences, Wayne State University College of Medicine, Detroit, MI.
Check complete blood count, electrolytes, thyroid panel, urinalysis, urine drug screen, blood urea nitrogen, and creatinine to rule out an underlying metabolic or endocrinologic cause for psychosis. Watch for signs of anticholinergic syndrome during physical examination.
If any of the above results suggest a medical problem, test for the following as clinical suspicion warrants:
serum copper/ceruloplasmin and liver function to rule out Wilson’s disease, a genetic disorder that causes copper to accumulate in the liver and brain
systemic lupus erythematosus
lead, magnesium, mercury, or manganese to rule out metal poisoning.
Order additional blood testing to check for vitamin B12 deficiency, brain MRI to rule out Alzheimer’s or subcortical dementia, EEG to check for an infectious or malignant disorder or for cerebral dysfunction, or ECG to rule out a metabolic or degenerative disorder or electrolyte imbalance.
Related resources
Cronin AJ. The Citadel. Boston: Little, Brown & Co.;1937:399.
Asher R. Myxoedamatous madness. BMJ 1949;2:555-62.
Drug brand names
Aripiprazole • Abilify
Captopril • Capoten
Clozapine • Clozaril
Haloperidol • Haldol
Levothyroxine • Synthroid
Olanzapine • Zyprexa
Risperidone • Risperdal
Disclosures
The author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
