Abstract
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.
Similar content being viewed by others
REFERENCES
Sheline Y, Kehr C: Cost and utility of routine admission laboratory testing for psychiatric inpatients. Gen Hosp Psychiatry 1990; 12:329–334
Anfinson TJ, Kathol RG: Screening laboratory evaluation in psychiatric patients: A review. Gen Hosp Psychiatry 1992; 14:248–257
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; 78:57–63
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; 40:168–172
Domisse J: Subtle vitamin deficiency and psychiatry: A largely unnoticed but devastating relationship? Med Hypotheses 1991; 34:137–140
O'Neill D, Barber RD: Reversible dementia caused by vitamin B12 deficiency. J Am Geriatr Soc 1993; 41:192–193
Catalano G, Catalano MC, Rosenberg EI, Embi PJ, Embi CS: Catatonia: Another neuropsychiatric presentation of vitamin B12 deficiency? Psychosomatics 1998; 39:456–460
Newbold HL: Vitamin B12: Placebo or neglected therapeutic tool? Med Hypotheses 1989; 28:155–164
Smith ADM: Megaloblastic madness. BMJ 1960; 2:1840–1845
Greenberg DB: Cobalamin deficiency. In: Rundell JR, Wise MG, eds. The American Psychiatric Press Textbook of Consultation-Liaison Psychiatry. Washington: American Psychiatric Press; 1996; 586
VanTiggelen CJM, Peperkamp JPC, TerToolen JFW: Vitamin-B12 levels of cerebrospinal fluid in patients with organic mental disorder. J Orthomol Psychiatry 1983; 12:305–311
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; 42:65–71
Bottiglieri T: Folate, vitamin B12, and neuropsychiatric disorders. Nutr Rev 1996; 54:382–390
Bottiglieri T, Hyland K, Reynolds EH: The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs 1994; 48:137–152
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; 154:426–428
Wesson VA, Levitt AJ, Joffe RT: Change in folate status with antidepressant treatment. Psychiatry Res 1994; 53:313–322
Greenberg DB: Fatigue. In: Rundell JR, Wise MG, eds. The American Psychiatric Press Textbook of Consultation-Liaison Psychiatry. Washington: American Psychiatric Press; 1996; 587–594
Van Gorp WG, Cummings JL: Neuropsychiatric aspects of infectious disorders. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. Baltimore: Williams & Wilkins; 1995; 235–241
Kaplan HI, Sadock BJ: Kaplan and Sadock's Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry, 8th edn. Baltimore: Williams & Wilkins; 1998
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; 35:526–531
Stern RA, Prange AJ: Neuropsychiatric aspects of endocrine disorders. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. Baltimore: Williams & Wilkins; 1995; 241–251
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; 50:807–811
Teunisse S, Bollen AE, van Gool WA, Walstra GJM: Dementia and subnormal levels of B12: Effects of replacement therapy on dementia. J Neurol 1996; 243:522–529
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; 42:933–936
Naughton BJ, Moran MB: Patterns of syphilis testing in the elderly. J Gen Intern Med 1992; 7:273–275
Ryan WG, Roddam RF, Grizzle WE: Thyroid function screening in newly admitted psychiatric inpatients. Ann Clin Psychiatry 1994; 6:7–12
White AJ, Barraclough B: Benefits and problems of routine laboratory investigations in adult psychiatric admissions. Br J Psychiatry 1989; 155:65–72
Mookhoek EJ, Sterrenburg-v.d.Nieuwegiessen IM: Screening for somatic disease in elderly psychiatric patients. Gen Hosp Psychiatry 1998; 20:102–107
Brett AS, Roberts MS: Screening for vitamin B12 deficiency in psychiatric patients. J Gen Intern Med 1994; 9:522–524
Romfh RF: The appropriateness of routine diagnostic studies. Mil Med 1898; 54:140–144
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; 35:67–73
Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER: Depression: A neglected major illness. J Clin Psychiatry 1993; 54:419–426
Kaplan HI, Sadock BJ: Synopsis of Psychiatry. Baltimore: Williams & Wilkins; 1998
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Catalano, G., Catalano, M.C., O'Dell, K.J. et al. The Utility of Laboratory Screening in Medically Ill Patients with Psychiatric Symptoms. Ann Clin Psychiatry 13, 135–140 (2001). https://doi.org/10.1023/A:1012229407218
Issue Date:
DOI: https://doi.org/10.1023/A:1012229407218