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<< The Depressed Patient And Suicidal Patient In The Emergency Department: Evidence-Based Management And Treatment Strategies

Diagnostic Studies

Depression and suicidality are clinical diagnoses based on a detailed history by the emergency clinician.
Laboratory studies are used to assess for medical etiologies of the presentation as well as to identify any
possible toxic-metabolic abnormalities such as those resulting from deliberate poisoning or substance
abuse. Basic medical laboratory work often includes complete blood count (CBC), chemistries, urinalysis, electrocardiogram (ECG), urine pregnancy test (if female), serum drug levels for alcohol and/or medication, and urine toxicology screen for drugs of abuse. If the patient is on certain psychotropic medications with known toxic effects (such as lithium), levels should be drawn. A clinical policy released by ACEP in 2006 regarding diagnosis and management of the adult psychiatric patient in the ED noted a Level B recommendation for obtaining routine laboratory testing in alert, cooperative patients with normal vital signs and a nonfocal history and physical examination.85 Furthermore, a Level C recommendation was made for the routine use of urine drug screen in the same population of alert, cooperative psychiatric patients. In other words, urine toxicology screens for drugs of abuse should not delay patient evaluation for transfer to a psychiatric facility; such conversations should be had institution-to-institution between the two services.

Though rare, imaging studies of the brain such as computed tomography or magnetic resonance imaging might be indicated if there is a high degree of suspicion for an anatomical lesion. Endocrine etiologies of depressive symptoms are always a consideration, and there is a low threshold for checking a thyroid stimulating hormone (TSH) level in depressed patients.

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Last Modified: 10/19/2017
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