Psychiatric/physical differential

Hi Doctors,

I’m a student MSc mental health nurse in the UK and had a question around physical examinations for potential psychiatric diagnoses. If a patient presents on first contact with sleep problems, low motivation, appetite problems etc then my initial puzzle pieces lead to depression but I may be biased. How important would it be for anybody that presents with these vague concerns to get some physical checks done to check for hypothyroidism, diabetes, anemia etc? Would this be a first line set of investigations along with history taking?

Thanks

Essentially all primary psychiatric diagnoses require that the syndrome NOT be due to an underlying medical cause or substance use. So the history taking should also include questions evaluating signs or risk factors for such conditions, and it is common to check things like basic blood counts and chemistries, as well as certain other tests on a case by case basis.

Great, thanks for this response. Often when shadowing advanced nurse practitioners, mental health practitioners or even GP’s sometimes I have noticed that SSRI’s are prescribed early on before any in depth investigations which always puzzled me. I would rather know that I’m not just helping to mask and underlying physical cause. The usual answer to my questions are “this is clearly depression/anxiety”.

Not every person needs an extremely in-depth set of testing, but this is generally not how I would do things.