Dating psychiatric patients
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Our study suggests that routine laboratory screening provides no additional information to that obtained from a thorough history and clinical examination in patients at high risk of having an underlying medical cause of presenting psychotic symptoms.
Their entry point in most cases is via the EC, which places additional strain on emergency facilities.The high incidence of mental health disorders in adolescence, when many adult mental health conditions begin, is expected to increase because of increasing social stressors such as poverty, displacement and conflict in low-income areas.Diagnosing mental health disorders in the EC is made more difficult because they can co-exist with medical conditions including HIV/AIDS, which itself can present with mental health disturbances.The prevalence of HIV/AIDS in the WC is estimated to be 5.3% in persons aged 15 - 49 years.Mental health disorders, specifically psychosis, can also be precipitated by recreational drugs.In the WC mental health (including substance abuse) is one of the top five contributors to the burden of disease, placing significant strain on local health care resources.
At the EC, patients with a mental health disorder are assessed by emergency medical personnel to exclude underlying medical causes that would explain their presentation, before being referred to mental health practitioners.
The WC guidelines for investigation of psychiatric patients state that patients with a first presentation of a psychotic disorder must have a serological test for syphilis and an HIV test, with consent, if clinically indicated.
This guideline has been expanded to recommend that patients with a psychiatric illness and low clinical suspicion of a general medical condition need only a clinical examination with basic observations and a random blood glucose level measurement in the EC before referral to the mental health services (patients Despite these guidelines, routine testing carried out in ECs in Cape Town includes WCC, serum sodium and electrolytes, syphilis serology, HIV testing and thyroid function testing.
Such 'blanket screening' of patients who present with mental health disorders is unnecessary and to detect treatable co-morbid medical conditions early.
However, most missed medical cases are due to an inadequate history and clinical examination rather than failing to perform blanket laboratory and radiological investigations.
Furthermore, some patients re-present frequently to the EC with acute psychosis, often resulting in multiple re-testing within a short period of time.