Urine Drug Screens: What You Need to Know

Topics: Laboratory Testing in Psychiatry | screening | Technology | urine toxicology

What should you do with unexpected urine toxicology results? When should you suspect a false test? What is confirmatory testing? In this article, we’ll answer these questions and more, giving you everything you need to know about urine toxicology testing in the clinical setting. The tests: Screening and confirmation There are two types of urine

Lab Testing for Patients with Substance Use Disorders

Topics: Laboratory Testing in Psychiatry | screening | urine toxicology

CATR: Can you tell us a little about yourself? Dr. Becker: I’m a general internist with a specialty in addiction medicine and pain management. I spend my time doing clinical research and directing a pain clinic for patients with opioid misuse and opioid use disorder (OUD). CATR: What labs do you order for a new patient? Dr. Becker: To start,

Alcohol-Induced Liver Disease

Topics: Alcohol related liver disease | Alcohol use disorder | Laboratory Testing in Psychiatry

CATR: Many non-specialists find the jargon of the liver field confusing. Can we start by reviewing the relevant terminology that clinicians should be familiar with? Dr. Bataller: The best way to do that is by reviewing the natural history of alcohol-related liver disease. Most people who drink excessively accumulate fat in the liver; this is an early s

Biomarkers of Alcohol Use

Topics: Addiction | Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Laboratory Testing in Psychiatry | Substance Use Disorder

We all want to know how much alcohol our patients are drinking. Asking patients directly about their drinking often generates useful information and helps build rapport, but this tactic is not always reliable. Denial and shame as well as issues related to secondary gain can sometimes contaminate self-report. Thankfully, there are many measures that can

Thyroid Augmentation in Bipolar Disorder

Topics: Anxiety | Bipolar Disorder | Depression | Laboratory Testing in Psychiatry | Mania | Pharmacology | Side Effects

TCPR: When do you use thyroid augmentation in bipolar disorder?Dr. Kelly: It may be useful for treatment-resistant bipolar depression, and I emphasize treatment-resistant because that is where the empiric support lies. Now, the evidence is not rock-solid, but when it comes to treatment-resistant bipolar depression we don’t have much else to draw on ex

Genetic Testing: What You Need to Know in 2021

Topics: Autism Spectrum Disorder | CYP2C19 | CYP2D6 | GeneSight | Genetic Testing | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Learning & Developmental Disabilities | Pharmacogenomics | Treatment-Resistant Depression | Whole Genome Sequencing

TCPR: Is there a role for genetic testing in clinical practice? Dr. Nurnberger: I think the evidence is growing that there’s a place for this in clinical practice. The meta-analyses of pharmacogenetic tests are actually looking pretty favorable recently, at least for some genes, particularly CYP2D6 and 2C19 (Bousman CA et al, Pharmacogenomics 2019;20

Inflammatory Biomarkers in Depression

Topics: Bupropion | C-Reactive Protein | CRP | Depression | Depressive Disorder | Dopamine | Exercise | Inflammation | Laboratory Testing in Psychiatry | Medical Comorbidities | Norepinephrine | Nortriptyline | Nutrition | Obesity | Treatment-Resistant Depression | Wellbutrin

TCPR: What is inflammation? Dr. Miller: Inflammation is the body’s natural response to infection or wounding. It’s important for survival, but if it goes on too long it damages the body in various ways. It contributes to heart disease, cancer, metabolic disorders, and neurodegenerative disorders. Ultimately, it can change set points in the brain th

Highlights From This Issue

Topics: Bupropion | C-Reactive Protein | CRP | Depression | Depressive Disorder | Dopamine | Exercise | Inflammation | Laboratory Testing in Psychiatry | Medical Comorbidities | Norepinephrine | Nortriptyline | Nutrition | Obesity | Treatment-Resistant Depression | Wellbutrin

Inflammation contributes to treatment resistance in depression and can be measured with a blood test, C-reactive protein (CRP). An elevated CRP predicts a favorable response to certain antidepressants, as well as specific lifestyle interventions. Nuedexta’s expanded use in dementia is based on questionable efficacy, but it is safer than many

Determining Dementia

Topics: Dementia | Diagnostic Testing | Laboratory Testing in Psychiatry

TCPR: The big question for general psychiatrists is how do we go about efficiently assessing memory in a clinical environment that only allows for a 15- to 20-minute visit? Dr. Budson: If people are actually raising a concern about their memory, that is already something to take seriously. There used to be this rule of thumb that you don’t need to

Pharmacogenetic Testing: An Update

Topics: Diagnostic Testing | Free Articles | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

Given how many essentially equivalent medications we have to choose from, how great would it be to have a test that tells us which drug to prescribe for which patient? Everybody wants personalized medicine, and in some other specialties, such as oncology, this is becoming a standard part of treatment. In this article, we’ll review some of the basics o

Understanding Pharmacogenetics Research

Topics: Diagnostic Testing | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

TCPR: Dr. Uher, you have been a co-investigator on the major studies of pharmacogenetics in psychiatry. It’s a complicated field, and I thought you could explain how the research is actually done. Dr. Uher: The basic goal of this kind of research is to try to find an association between a genetic variant and the clinical response to a particular m

Before You Write That Prescription: Guidelines for Ordering Lab Tests

Topics: Laboratory Testing in Psychiatry | News of Note | Practice Tools and Tips | Psychopharmacology Tips

Mental health clinicians often ask for a single, black-and-white answer to the question: Which lab tests should I order before starting this particular medication? Inevitably, the answer is that it depends. However, there are some guidelines that are useful. When it comes to ordering lab tests, it sometimes feels like we are “damned if we do, and d

Distinguishing Between Medical and Psychiatric Conditions

Topics: Laboratory Testing in Psychiatry | Medical Comorbidities | Practice Tools and Tips | Psychopharmacology Tips

Using Psychiatric Biomarkers in your Practice

Topics: Addiction | Diagnostic Testing | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

Treatment of the psychiatric patient is as much an art as it is a science. Diagnosing and deciding on treatments in psychiatry is based on a series of human interactions. We observe and we listen to patients, we ask questions, we consider their responses, and we synthesize all this information in order to render a judgment. Such judgments are subjective

How to Evaluate the Methodology of Biomarker Studies

Topics: Addiction | Genetics and Psychiatry | Laboratory Testing in Psychiatry | Practice Tools and Tips

A Primer on Drug Screening

Topics: Diagnostic Testing | Laboratory Testing in Psychiatry | Practice Tools and Tips

The technology of drug testing has progressed significantly over the years. This is both good and bad for doctors. There are more options, but perhaps too many. There are many types of tests and they vary in terms of the drug detection time frames. Most labs do the initial screen with immunoassays, which involve antibodies to detect specific drugs, a

Ordering Toxicology Screening: Clinical Tips

Topics: Diagnostic Testing | Laboratory Testing in Psychiatry | Practice Tools and Tips

Clinical Trials: Show Us the Data

Topics: Laboratory Testing in Psychiatry | Pharmaceutical Industry

“It is no longer possible to pretend that a report of a clinical trial in a medical journal is enough to allow full independent scrutiny ….” Fiona Godlee, Editor, British Medical Journal (BMJ) Too often our literature presents an oversimplified picture driven by some agenda, usually commercial. We prescribers, or, more accurately, “research c

Tips When Reviewing Labs

Topics: Laboratory Testing in Psychiatry | Practice Tools and Tips

Dhwani Shah, MD Associate Clinical Professor of Psychiatry, University of Pennsylvania School of Medicine Lisa Rosenthal, MD Assistant Professor of Clinical Psychiatry, University of Pennsylvania School of Medicine Dr. Shah and Dr. Rosenthal report no financial relationships with any commercial companies related to this article. It’s easy to

Screening Labs for New Patients: Are they Useful?

Topics: Laboratory Testing in Psychiatry

Dr. George Lundberg, former editor-in-chief of JAMA and current editor of Medscape General Medicine, once cautioned physicians against the excessive use of routine labs: “The more lab tests that are done, the greater the chance for an abnormal result, whether or not the patient is sick” (see http://www.medscape.com/ viewarticle/495665). In psychi