Clinical Laboratory Medicine for Mental Health Professionals

by Sandra A. Jacobson MD

Overview

A revised, abridged version of the seminal work, Laboratory Medicine in Psychiatry and Behavioral Science, Clinical Laboratory Medicine for Mental Health Professionals more directly address the needs of general psychiatrists and their mental health colleagues in clinical practice.

Sections on laboratory tests, diseases and conditions, and psychotropic medications include alphabetically arranged entries, making it easy for busy clinicians to reference the updated information. For each laboratory test, the following information is provided: • The type of test (e.g., blood, urine, etc.)• An explanation of the test• The test's relevance to psychiatry• Patient preparation• Medical and psychiatric indications for the test• Numerical reference ranges• Critical values for test results• The potential meaning of abnormal results (e.g., factors that lead to increased or decreased levels)• Interfering factors• Cross-references to other tests or conditions

Information on clinical diagnosis and laboratory testing is provided for diseases and conditions, and psychotropic medications are examined from both a screening and a monitoring standpoint. Extensively indexed, this guide also includes an appendix that features at-a-glance information on therapeutic and psychotropic levels, 10 rules for deciding whether an ECG is normal, and several figures covering topics relevant to tests, such as ECG waves and intervals, cholestatic injury, bilirubin cycle, and SIADH secretion.

Years of clinical practice and research inform both the choice of tests included and the rationale for their use, making Clinical Laboratory Medicine for Mental Health Professionals the definitive, authoritative reference for psychiatrists and other behavioral health clinicians.

Product Details

ISBN-13:	9781615370849
Publisher:	American Psychiatric Association Publishing
Publication date:	12/19/2016
Pages:	388
Product dimensions:	7.00(w) x 9.90(h) x 0.90(d)
Age Range:	18 Years

About the Author

Sandra A. Jacobson, M.D., is with the University of Arizona College of Medicine Phoenix in Phoenix, Arizona.

Table of Contents

Preface xi

Introduction xiii

About the Author xvii

Chapter 1 Laboratory Tests 1

Alanine transaminase (ALT) 2

Albumin 5

Alkaline phosphatase (ALP) 7

Alprazolam level 10

Ammonia (NH₃) 11

Amylase 13

Antinuclear antibody (ANA) test 15

Apolipoprotein E (ApoE) genotyping 18

Aspartate transaminase (AST) 19

Basic metabolic panel (BMP) 22

Bilirubin 23

Blood alcohol level (BAL) 26

Blood urea nitrogen (BUN) 28

Calcium (Ca⁺⁺) 30

Carbamazepine level 34

Carbohydrate-deficient transferrin (CDT or % CDT) 35

Carbon dioxide (CO₂) 37

Chest X ray (CXR) 39

Chlordiazepoxide level 41

Chloride (Cl^-) 42

Clonazepam level 44

Clozapine level 45

Complete blood count (CBC) 46

Comprehensive metabolic panel (CMP) 48

Cranial computed tomography (head CT or CAT scan) 49

Creatine kinase (CK) (also known as creatine phosphokinase [CPK]) 52

Creatinine (Cr) 56

Cytochrome P450 (CYP450) genotyping: AmpliChip CYP450 test 59

Diazepam level 61

Drug screen (toxicology screen) 62

Electrocardiogram (ECG or EKG) 65

Electroencephalogram (EEG) 68

Electrolytes panel 71

Ethylene glycol level 72

Flurazepam level 73

Folate (also known as folic acid) 74

Gamma-glutamyltransferase (GGT) 76

Glucose (blood sugar) 78

Hematocrit (Hct) 81

Hemoglobin (Hb) 83

Hemoglobin A_1C (HbA_1C) 85

Hepatitis panel 87

HIV testing 89

Lipase 91

Lipid panel 93

Lithium level 97

Liver function tests (LFTs) 99

Lorazepam level 102

Magnesium (Mg⁺⁺) 103

Magnetic resonance imaging (MRT) 106

Mean corpuscular volume (MCV) 110

Methanol level 112

Multiple sleep latency test (MSLT); maintenance of wakefulness test (AHAT) 113

Osmolality (serum and urine) 115

Oxazepam level 119

Phosphate (also known as phosphorus) 120

Platelet count 123

Polysomnography (PSG) 126

Positron emission tomography (PET): brain 128

Potassium (K⁺) 130

Prealbumin 133

Prolactin (PRL) 135

Protein 138

Pyridoxine (vitamin B₆) 140

Red blood cell count (RBC) 142

Renal function panel 144

Single-photon emission computed tomography (SPECT) 145

Sodium (Na⁺) 147

Syphilis testing 149

Temazepam level 151

Thiamine (vitamin B₁) 152

Thyroid function testing: free thyroxine (free T₄; FT₄) 154

Thyroid function testing: thyroid-stimulating hormone (TSH) 156

Triglycerides 159

Tuberculosis (TB) testing 162

Uric acid 164

Urinalysis (UA) 166

Valproate level 169

Vitamin B₁₂ 170

Vitamin D 172

White blood cell count (WBC) 174

Wilson disease screening panel 176

Chapter 2 Diseases and Conditions 179

Alcohol use disorder (alcoholism) 180

Anorexia nervosa 182

Anxiety disorder (secondary): substance/medication-induced or due to another medical condition 184

Attention-deficit/hyperactivity disorder (ADHD) 185

Autism spectrum disorder (ASD) 186

Catatonia disorder due to another medical condition 187

Delirium 188

Diabetes mellitus 190

Down syndrome (trisomy 21) 191

Eating disorders 192

Ethylene glycol poisoning 194

Fatty Liver disease (nonalcoholic) 195

Folate deficiency 196

Generalized anxiety disorder (GAD) 197

Hepatic encephalopathy (HE) 198

Hepatitis (viral) 200

HIV/AIDS 201

Hydrocephalus 203

Hyperthyroidism 204

Hypothyroidism 206

Intellectual disability 207

Lead poisoning 208

Major depressive episode 210

Manic episode 211

Metabolic syndrome 213

Methanol poisoning 214

Neuroleptic malignant syndrome (NMS) 215

Obsessive-compulsive disorder (OCD) 216

Panic attack; panic disorder 217

Pica 219

Polydipsia (psychogenic) 220

Psychotic disorder due to another medical condition 221

Restless legs syndrome (RLS) 223

Sarcoidosis 224

Schizophrenia 226

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 228

Thiamine (vitamin B₁) deficiency 230

Tuberculosis (TB) 232

Vitamin B₁₂ deficiency 234

Wernicke-Korsakoff syndrome 236

Chapter 3 Psychotropic Medications: Laboratory Screening and Monitoring 239

Acamprosate (Campral) 240

Amphetamines (Adderall); dextroamphetamines (Dexedrine); lisdexamfetamine dimesylate (Vyvanse) 241

Antipsychotic medications, first-generation (typical) 242

Antipsychotic medications, second-generation (atypical) 243

Atomoxetine (Strattera) 244

Benzodiazepines 245

Buprenorphine (Buprenex, Subutex); buprenorphine/naloxone (Suboxone) 246

Bupropion (Aplenzin, Budeprion SR, Wellbutrin) 247

Buspirone 248

Carbamazepine 249

Clozapine (Clozaril, FazaClo, Versacloz) 250

Donepezil (Aricept) 252

Duloxetine (Cymbalta) 253

Gahapentin 254

Galantamine (Razadyne) 255

Lamorrigine (Lamictal) 256

Levetiraeetam (Keppra) 257

Lithium 258

ATethylphenidate (Ritalin, Concerts) 259

Mirtazapine (Remeron) 260

Monoamine oxidase inhibitors (MAOIs) 261

Naltrexone (ReVia, Vivitrol) 262

Nefazodone 263

Nonbenzodiazepine hypnotics: eszopiclone (Lunesta), zaleplon (Sonata), Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist) 264

Opioids 265

Oxcarbazepine (Trileptal) 266

Ramelteon (Rozerem) 267

Rivastigmine (Exelon) 269

Selective serotonin reuptake inhibitors (SSRIs) 269

Topiramate (Topamax) 270

Tramadol (Ultram) 271

Trazodone (Desyrel, Oleptro) 272

Tricyclic antidepressants (TCAs) 273

Valproate 275

Venlafaxine (Effexor); desvenlafaxine (Pristiq) 276

Appendix 277

Therapeutic and Toxic Drug Levels at a Glance 279

Ten Rules for a Normal Electrocardiogram 280

Figure 1 The Electrocardiogram: Waves and Intervals 281

Figure 2 Hy's Law 282

Figure 3 Cholestatic Injury 282

Figure 4 Bilirubin Cycle 283

Figure 5 Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 284

References 287

Index 295

What People are Saying About This

Linda L.M. Worley

This useful resource includes a broad dictionary defining the relevance of pertinent laboratory tests and their values; a listing of DSM-5 psychiatric conditions with specific recommendations regarding differential diagnostic testing; and a guide for pre-screening laboratory testing and monitoring to accompany the prescription of psychotropic medications. This exceptional guide will be a handy tool to rely on as we educate patients about the need for testing and the meaning of those results. Thank you to Dr. Jacobson for this handy reference tool to reinforce high quality medical/psychiatric care!

Catherine Crone

Dr. Jacobson has provided an excellent and practical reference for mental health professionals that encompasses the majority of laboratory tests and other tests (e.g. EEG, PET, MSLT) one either needs to consider or encounters during the care of psychiatric patients. The chapter organization by individual test, as well as by specific psychiatric disorder and psychiatric medication, make it easy to use and something a clinician can quickly turn to in daily practice. The information provided is clearly written and easy to grasp such that both trainee or seasoned clinician can benefit from this book.

Editorial Reviews

Reviewer: Valerie L Ng, PhD MD(Alameda County Medical Center/Highland Hospital)
Description: This laboratory medicine reference manual for general psychiatric practice is abridged from Laboratory Medicine in Psychiatry and Behavioral Science, Jacobson (American Psychiatric Association Publishing, 2012).
Purpose: The purpose is to assist general psychiatrists and other behavioral health specialists in providing psychiatric care to patients in a variety of settings (e.g., inpatient, outpatient, day hospital, in consultation in the general hospital, disabled or geriatric in long-term care). These are worthy objectives well met by this book.
Audience: It is intended for general psychiatrists or behavioral health specialists. It would also be useful as a general guide in the laboratory for allied health providers (e.g., pharmacists, clinical laboratory scientists, etc.), advance practice practitioners (e.g., nurse practitioners, physician assistants, etc.) and those very early in their medical training (e.g., medical students) wanting more information on laboratory test use and interpretation.
Features: This concisely written handbook has three unevenly sized chapters. Chapter 1 (176 pages) is an alphabetical annotated listing and description of commonly used laboratory tests. Each test description is in a standard table format consisting of an explanation of the test, relevance to psychiatry, patient preparation, indications for testing, reference range, and critical results. Certain tests with more nuances are described in much greater detail — for example the discussion of urine drugs of abuse testing has a surprisingly sophisticated discussion of opiate metabolism and how to determine if the positive result is from codeine versus illicit substance ingestion. Chapter 2 (57 pages) discusses common general diseases and conditions. Chapter 3 (37 pages) discusses screening and monitoring of psychotropic medication. The use of tables throughout the book is a nice standardization feature and calls attention to key points. Although this has a laboratory medicine focus, I liked the broader inclusion of commonly performed physical assessments (e.g., waist circumference and weight/BMI) as part of the recommended "laboratory tests" for monitoring psychotropic medications. Finally there is a five-page appendix with deceptively simple yet pedagogically rich diagrams (e.g., "10 rules for a normal ECG", bilirubin cycle, SIADH, etc.). The 75-page index is highly cross referenced and most helpful.
Assessment: This handy book would be very helpful to general psychiatrists or behavioral health practitioners wanting basic and concise information on commonly used clinical laboratory tests in the treatment and management of psychiatric disorders.

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