Annals of Clinical Psychiatry

, Volume 13, Issue 3, pp 135–140 | Cite as

The Utility of Laboratory Screening in Medically Ill Patients with Psychiatric Symptoms

  • Glenn Catalano
  • Maria C. Catalano
  • Kristin J. O'Dell
  • Deborah A. Humphrey
  • Emma B. Fritz


The presence of psychiatric illness in general hospital medical inpatients can complicate a patient's clinical course. Currently, there is no standard laboratory work-up recommended for this patient population. To begin to assess the utility of a routine panel of tests, the results of serum vitamin B12 (cobalamin) levels, folate levels, thyroid stimulating hormone levels, and syphilis serology of 349 patients were reviewed. These patients had been admitted to the hospital for nonpsychiatric conditions but either had preexisting psychiatric disturbances or developed a mood spectrum disorder or cognitive spectrum disorder during their hospitalization. The incidence of vitamin B12 and folate deficiencies in these patients was found to be higher than has been reported for the general population. Thus, routine screening for these vitamin deficiencies may be indicated because of their prevalence in this patient population.

screening tests psychiatry thyroid function tests vitamin B12 folate syphilis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sheline Y, Kehr C: Cost and utility of routine admission laboratory testing for psychiatric inpatients. Gen Hosp Psychiatry 1990; 12:329–334Google Scholar
  2. 2.
    Anfinson TJ, Kathol RG: Screening laboratory evaluation in psychiatric patients: A review. Gen Hosp Psychiatry 1992; 14:248–257Google Scholar
  3. 3.
    Stott DJ, Langhorne P, Hendry A, McKay PJ, Holyoake T, Macdonald J, Lucie N: Prevalence and haemopoiectic effects of low serum vitamin B12 levels in geriatric medical patients. Brit J Nutr 1997; 78:57–63Google Scholar
  4. 4.
    Martin DC, Francis J, Protetch J, Huff J: Time dependency of cognitive recovery with cobalamin replacement: Report of a pilot study. J Am Geriatr Soc 1992; 40:168–172Google Scholar
  5. 5.
    Domisse J: Subtle vitamin deficiency and psychiatry: A largely unnoticed but devastating relationship? Med Hypotheses 1991; 34:137–140Google Scholar
  6. 6.
    O'Neill D, Barber RD: Reversible dementia caused by vitamin B12 deficiency. J Am Geriatr Soc 1993; 41:192–193Google Scholar
  7. 7.
    Catalano G, Catalano MC, Rosenberg EI, Embi PJ, Embi CS: Catatonia: Another neuropsychiatric presentation of vitamin B12 deficiency? Psychosomatics 1998; 39:456–460Google Scholar
  8. 8.
    Newbold HL: Vitamin B12: Placebo or neglected therapeutic tool? Med Hypotheses 1989; 28:155–164Google Scholar
  9. 9.
    Smith ADM: Megaloblastic madness. BMJ 1960; 2:1840–1845Google Scholar
  10. 10.
    Greenberg DB: Cobalamin deficiency. In: Rundell JR, Wise MG, eds. The American Psychiatric Press Textbook of Consultation-Liaison Psychiatry. Washington: American Psychiatric Press; 1996; 586Google Scholar
  11. 11.
    VanTiggelen CJM, Peperkamp JPC, TerToolen JFW: Vitamin-B12 levels of cerebrospinal fluid in patients with organic mental disorder. J Orthomol Psychiatry 1983; 12:305–311Google Scholar
  12. 12.
    Mitsuyama Y, Kogoh H: Serum and cerebrospinal fluid vitamin B12 levels in demented patients with CH3–B12 treatment-preliminary study. Jpn J Psychiatry Neurol 1988; 42:65–71Google Scholar
  13. 13.
    Bottiglieri T: Folate, vitamin B12, and neuropsychiatric disorders. Nutr Rev 1996; 54:382–390Google Scholar
  14. 14.
    Bottiglieri T, Hyland K, Reynolds EH: The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs 1994; 48:137–152Google Scholar
  15. 15.
    Fava M, Borus JS, Alpert JE, Nierenberg AA, Rosenbaum JF, Bottiglieri T: Folate, vitamin B12, and homocysteine in major depressive disorder. Am J Psychiatry 1997; 154:426–428Google Scholar
  16. 16.
    Wesson VA, Levitt AJ, Joffe RT: Change in folate status with antidepressant treatment. Psychiatry Res 1994; 53:313–322Google Scholar
  17. 17.
    Greenberg DB: Fatigue. In: Rundell JR, Wise MG, eds. The American Psychiatric Press Textbook of Consultation-Liaison Psychiatry. Washington: American Psychiatric Press; 1996; 587–594Google Scholar
  18. 18.
    Van Gorp WG, Cummings JL: Neuropsychiatric aspects of infectious disorders. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. Baltimore: Williams & Wilkins; 1995; 235–241Google Scholar
  19. 19.
    Kaplan HI, Sadock BJ: Kaplan and Sadock's Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry, 8th edn. Baltimore: Williams & Wilkins; 1998Google Scholar
  20. 20.
    Tappy L, Randin JP, Schwed P, Wertheimer J, Lemarchand-Beraud T: Prevalence of thyroid disorders in psychogeriatric inpatients: A possible relationship of hypothyroidism with neurotic depression but not with dementia. J Am Geriatr Soc 1987; 35:526–531Google Scholar
  21. 21.
    Stern RA, Prange AJ: Neuropsychiatric aspects of endocrine disorders. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. Baltimore: Williams & Wilkins; 1995; 241–251Google Scholar
  22. 22.
    Robertson KR, Stern RA, Hall CD, Perkins DO, Wilkins JW, Gortner DT, Donovan K, Messenheimer JA, Whaley R, Evans DL: Vitamin B12 deficiency and nervous system disease in HIV infection. Arch Neurol 1993; 50:807–811Google Scholar
  23. 23.
    Teunisse S, Bollen AE, van Gool WA, Walstra GJM: Dementia and subnormal levels of B12: Effects of replacement therapy on dementia. J Neurol 1996; 243:522–529Google Scholar
  24. 24.
    Crystal HA, Ortof E, Frishman WH, Gruber A, Hershman D, Aronson M: Serum vitamin B12 levels and incidence of dementia in a healthy elderly population: A report from the Bronx longitudinal aging study. J Am Geriatr Soc 1994; 42:933–936Google Scholar
  25. 25.
    Naughton BJ, Moran MB: Patterns of syphilis testing in the elderly. J Gen Intern Med 1992; 7:273–275Google Scholar
  26. 26.
    Ryan WG, Roddam RF, Grizzle WE: Thyroid function screening in newly admitted psychiatric inpatients. Ann Clin Psychiatry 1994; 6:7–12Google Scholar
  27. 27.
    White AJ, Barraclough B: Benefits and problems of routine laboratory investigations in adult psychiatric admissions. Br J Psychiatry 1989; 155:65–72Google Scholar
  28. 28.
    Mookhoek EJ, Sterrenburg-v.d.Nieuwegiessen IM: Screening for somatic disease in elderly psychiatric patients. Gen Hosp Psychiatry 1998; 20:102–107Google Scholar
  29. 29.
    Brett AS, Roberts MS: Screening for vitamin B12 deficiency in psychiatric patients. J Gen Intern Med 1994; 9:522–524Google Scholar
  30. 30.
    Romfh RF: The appropriateness of routine diagnostic studies. Mil Med 1898; 54:140–144Google Scholar
  31. 31.
    Adams M, Kutcher S, Antoniw E, Bird D: Diagnostic utility of endocrine and neuroimaging screening tests in first-onset adolescent psychosis. J Am Acad Child Adolesc Psychiatry 1996; 35:67–73Google Scholar
  32. 32.
    Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER: Depression: A neglected major illness. J Clin Psychiatry 1993; 54:419–426Google Scholar
  33. 33.
    Kaplan HI, Sadock BJ: Synopsis of Psychiatry. Baltimore: Williams & Wilkins; 1998Google Scholar

Copyright information

© American Academy of Clinical Psychiatrists 2001

Authors and Affiliations

  • Glenn Catalano
    • 1
  • Maria C. Catalano
    • 2
  • Kristin J. O'Dell
    • 2
  • Deborah A. Humphrey
    • 3
  • Emma B. Fritz
    • 4
  1. 1.Department of Psychiatry and Behavioral MedicineUniversity of South FloridaTampa
  2. 2.Psychiatry ServiceJames A. Haley Veterans' HospitalTampa
  3. 3.Department of Internal MedicineUniversity of South FloridaTampa
  4. 4.Department of Obstetrics and GynecologyArnold Palmer Hospital for Women and ChildrenOrlando

Personalised recommendations