Recommended Diagnostic Workup from APA Textbook
Selected Medical Conditions with Psychiatric Manifestations
Neurological
Cerebrovascular disease [major or mild vascular neurocognitive disorder]
Multiple sclerosis
Multiple systems atrophy
Parkinson’s disease [major or mild neurocognitive disorder due to Parkinson’s disease]
Progressive supra-nuclear palsy
Alzheimer’s disease [major or mild neurocognitive disorder due to Alzheimer’s disease]
Frontotemporal dementias [major or mild frontotemporal neurocognitive disorder]
Dementia associated with Lewy bodies [major or mild neurocognitive disorder with Lewy bodies]
Seizure disorder
Huntington’s disease [major or mild neurocognitive disorder due to Huntington’s disease]
Traumatic brain injury [major or mild neurocognitive disorder due to traumatic brain injury]
Anoxic brain injury
Migraine headache
Sleep disorders [narcolepsy, breathing-related sleep disorders]
Normal pressure hydrocephalus
Neoplastic
Central nervous system tumors, primary and metastatic
Pancreatic carcinoma
Paraneoplastic syndromes
Endocrine tumors
Pheochromocytoma
Infectious
HIV
Neurosyphilis
Creutzfeldt-Jakob’s disease
Systemic viral and bacterial infections
Viral and bacterial meningitis and encephalitis
Tuberculosis
Infectious mononucleosis
Pediatric acute-onset neuropsychiatric syndrome (PANS)
Nutritional
Vitamin deficiencies
B12: pernicious anemia
Folate: megaloblastic anemia
Nicotinic acid deficiency: pellagra
Thiamine deficiency: Wernicke-Korsakoff’s syndrome
Trace mineral deficiency (zinc, magnesium)
Autoimmune
Systemic lupus erythematosus
Sarcoidosis
Sjögren’s syndrome
Behcet’s syndrome
N-methyl-d-aspartate (NMDA) receptor encephalitis
Potassium channel antibody–mediated encephalitis
Endocrine/metabolic
Wilson’s disease
Fluid and electrolyte disturbances (syndrome of inappropriate antidiuretic hormone secretion [SIADH], central pontine
myelinolysis)
Porphyrias
Uremias
Recommended Diagnostic Workup from APA Textbook
Hypercapnia
Hepatic encephalopathy
Hypercalcemia/hypocalcemia
Hyperglycemia/hypoglycemia
Thyroid and parathyroid disease
Diabetes mellitus
Pheochromocytoma
Pregnancy
Gonadotropic hormonal disturbances
Panhypopituitarism
Drugs and toxins
Environmental toxins: organophosphates, heavy metals, carbon monoxide
Substance-related intoxication/withdrawal or delirium or substance-induced neurocognitive disorder
Adverse effects of prescription and over-the-counter medications
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Diagnostic Workup for Psychosis
Routine Screening
Consider Per Clinical Suspicion
Complete blood count with differential
 Antinuclear antibody
and platelets
 Rheumatoid factor
Serum chemistries, including liver and
 Blood cultures
renal function tests
 Serum B12 and folate levels
Thyroid-stimulating hormone
 Metal assays: serum and urine copper,
Rapid plasma reagin
serum ceruloplasmin, lead, mercury,
HIV serology
manganese
Erythrocyte sedimentation rate
 Cerebrospinal fluid analysis: red blood
cell count; white blood cell count;
Serum alcohol level
protein; glucose; opening pressure;
Urine toxicology screen
bacterial cultures; cryptococcal antigen;
Head computed tomography or brain
viral serologies
magnetic resonance imaging scan
Electroencephalogram
Urine pregnancy test
Baseline electrocardiogram
Therapeutic drug levels
Diagnostic Workup for Depressive or Manic Symptoms
Routine Screening
Consider Per Clinical Suspicion
Complete blood count with differential
 Structural neuroimaging (brain magnetic
and platelets
resonance imaging)
Serum chemistries, including liver and
 Electroencephalogram
renal function tests
Thyroid-stimulating hormone
Rapid plasma reagin
HIV serology
Urinalysis
Urine toxicology screen
Serum alcohol level (if suspected)
Urine pregnancy test
Electrocardiogram
Therapeutic drug levels (if patient is
already on psychiatric medications)
Recommended Diagnostic Workup from APA Textbook
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Diagnostic Workup for Anxiety
Routine Screening
Consider Per Clinical Suspicion
Serum chemistries, including liver and
 Referral for respiratory evaluation:
renal function tests
chest radiograph; pulmonary function
Serum glucose
tests
Thyroid-stimulating hormone
 Electroencephalogram
Referral for cardiac evaluation:
electrocardiogram, Holter monitoring,
stress test, and/or echocardiogram
Diagnostic Workup for Altered Mental Status
Routine Screening
Consider Per Clinical Suspicion
Serum chemistries, including liver and
 Cerebrospinal fluid analysis: red blood
renal function tests
cell count; white blood cell count;
Complete blood count
protein; glucose; opening pressure;
Erythrocyte sedimentation rate
bacterial cultures; cryptococcal antigen;
HIV serology
viral serologies
Antinuclear antibody
 Urine porphyrins
Rheumatoid factor
 Serum ammonia level
B12
 Brain magnetic resonance imaging
Folate
 Arterial blood gases
Rapid plasma reagin
 Blood cultures
Urinalysis
Urine toxicology
Serum alcohol level
Therapeutic drug levels
Electrocardiogram
Chest radiograph
Head computed tomography scan
Electroencephalogram
Diagnostic Workup for Cognitive Decline
Routine Screening
Consider Per Clinical Suspicion
Complete blood count with differential
 Rapid plasma reagin
and platelets
 HIV serology
Serum chemistries including liver and
 C-reactive protein
renal function tests
 Cerebrospinal fluid (CSF) analysis: red
Erythrocyte sedimentation rate
blood cell count; white blood cell count;
Antinuclear antibody
protein; glucose; opening pressure;
bacterial cultures; cryptococcal antigen;
Rheumatoid factor
viral serologies; CSF 14–3–3 protein
B12 and folate levels
immunoassay (if Creutzfeldt-Jakob
Thyroid-stimulating hormone
disease is suspected); CSF tau and Abeta
Structural neuroimaging studies (head
42 levels for frontotemporal dementia vs.
computed tomography or brain magnetic
Alzheimer’s disease
resonance imaging scan)
Recommended Diagnostic Workup from APA Textbook
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Urine porphyrins
Functional neuroimaging studies (single
photon emission computed tomography
or positron emission tomography)
Electroencephalogram
Apolipoprotein E genotyping
Neuropsychological testing
Fasting lipids, triglycerides, and blood
sugar when a vascular etiology is
suspected