Bipolar disorder laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
No laboratory test is required to establish the diagnosis of bipolar disorder. However, laboratory tests can help to exclude alternative etiologies for mood symptoms. Laboratory tests may include a [[urine]] [[toxicology]] screen and a [[complete blood count]]. Fasting [[glucose]] and [[lipid]] assessments are important for establishing the presence of [[diabetes]] or [[hyperlipidemia]]. | |||
==Bipolar disorder laboratory findings== | ==Bipolar disorder laboratory findings== | ||
* There are no diagnostic laboratory findings associated with Bipolar disorder. However, bipolar disorder enclose both depression and mania and it could be due to many reversible causes, an extensive range of tests is indicated | *There are no diagnostic laboratory findings associated with Bipolar disorder. However, bipolar disorder enclose both depression and mania and it could be due to many reversible causes, an extensive range of tests is indicated<ref name="pmid22534227">{{cite journal| author=Price AL, Marzani-Nissen GR| title=Bipolar disorders: a review. | journal=Am Fam Physician | year= 2012 | volume= 85 | issue= 5 | pages= 483-93 | pmid=22534227 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22534227 }}</ref> | ||
* Many number of medications that used to treat bipolar disorder have many side effect, for instance lithium requires an intact genitourinary system and can affect certain other systems. | *Many number of medications that used to treat bipolar disorder have many side effect, for instance lithium requires an intact genitourinary system and can affect certain other systems.<ref name="pmid225342272">{{cite journal| author=Price AL, Marzani-Nissen GR| title=Bipolar disorders: a review. | journal=Am Fam Physician | year= 2012 | volume= 85 | issue= 5 | pages= 483-93 | pmid=22534227 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22534227 }}</ref> | ||
* A complete blood count (CBC) with differential is to rule out anemia as a cause of depression in bipolar disorder. | *A complete blood count (CBC) with differential is to rule out anemia as a cause of depression in bipolar disorder.<ref name="pmid253173684">{{cite journal| author=Culpepper L| title=The diagnosis and treatment of bipolar disorder: decision-making in primary care. | journal=Prim Care Companion CNS Disord | year= 2014 | volume= 16 | issue= 3 | pages= | pmid=25317368 | doi=10.4088/PCC.13r01609 | pmc=4195640 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25317368 }}</ref> | ||
*Erythrocyte sedimentation rate to look for any underlying disease process such a lupus or an infection. | |||
* Erythrocyte sedimentation rate to look for any underlying disease process such a lupus or an infection. | *Fasting blood glucose level is indicated to rule out diabetes, as well as atypical antipsychotics are associated with weight gain and trouble with blood glucose regulation in patients with diabetes.<ref name="pmid253173683">{{cite journal| author=Culpepper L| title=The diagnosis and treatment of bipolar disorder: decision-making in primary care. | journal=Prim Care Companion CNS Disord | year= 2014 | volume= 16 | issue= 3 | pages= | pmid=25317368 | doi=10.4088/PCC.13r01609 | pmc=4195640 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25317368 }}</ref> | ||
* Fasting blood glucose level is indicated to rule out diabetes, as well as atypical antipsychotics are associated with weight gain and trouble with blood glucose regulation in patients with diabetes. | *Patients that will be on lithium therapy checking electrolytes is indicated, because low sodium levels may lead to higher lithium levels and lithium toxicity. | ||
* Patients that will be on lithium therapy checking electrolytes is indicated, because low sodium levels may lead to higher lithium levels and lithium toxicity. | *Check the serum calcium as any changes in serum calcium is associated with mental status changes (eg, hyperparathyroidism). An elevated calcium blood level can cause depression or mania.<ref name="pmid253173682">{{cite journal| author=Culpepper L| title=The diagnosis and treatment of bipolar disorder: decision-making in primary care. | journal=Prim Care Companion CNS Disord | year= 2014 | volume= 16 | issue= 3 | pages= | pmid=25317368 | doi=10.4088/PCC.13r01609 | pmc=4195640 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25317368 }}</ref> | ||
* Check the serum calcium as any changes in serum calcium is associated with mental status changes (eg, hyperparathyroidism). An elevated calcium blood level can cause depression or mania. | *In patients with depression as a result of not eating, low serum protein levels increase the availability of certain medications, because these drugs have less protein to which to bind. | ||
* In patients with depression as a result of not eating, low serum protein levels increase the availability of certain medications, because these drugs have less protein to which to bind. | *Thyroid function tests to rule out hyperthyroidism (mania) and hypothyroidism (depression). lithium can cause hypothyroidism, for that thyroid tests should be obtained.<ref name="pmid233803162">{{cite journal| author=Krishna VN, Thunga R, Unnikrishnan B, Kanchan T, Bukelo MJ, Mehta RK | display-authors=etal| title=Association between bipolar affective disorder and thyroid dysfunction. | journal=Asian J Psychiatr | year= 2013 | volume= 6 | issue= 1 | pages= 42-5 | pmid=23380316 | doi=10.1016/j.ajp.2012.08.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23380316 }}</ref> | ||
* Thyroid function tests to rule out hyperthyroidism (mania) and hypothyroidism (depression). lithium can cause hypothyroidism, for that thyroid tests should be obtained. | *In a study to assess the relationship between bipolar disorder and thyroid dysfunction, they found out that patients with bipolar disorder are two times more commonly associated with thyroid dysfunction than individuals without bipolar disorder.<ref name="pmid23380316">{{cite journal| author=Krishna VN, Thunga R, Unnikrishnan B, Kanchan T, Bukelo MJ, Mehta RK | display-authors=etal| title=Association between bipolar affective disorder and thyroid dysfunction. | journal=Asian J Psychiatr | year= 2013 | volume= 6 | issue= 1 | pages= 42-5 | pmid=23380316 | doi=10.1016/j.ajp.2012.08.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23380316 }}</ref> | ||
* In a study to assess the relationship between bipolar disorder and thyroid dysfunction, they found out that patients with bipolar disorder are two times more commonly associated with thyroid dysfunction than individuals without bipolar disorder. | *Creatinine and blood urea nitrogen should be checked because kidney failure can present as depression, treatment with lithium can affect urinary clearances. | ||
* Creatinine and blood urea nitrogen should be checked because kidney failure can present as depression, treatment with lithium can affect urinary clearances. | *Liver and lipid panel should be evaluated as many anti-psychotics medications cause changes in patients lipid profiles, resulting in dyslipidemia and liver damage.<ref name="pmid25317368">{{cite journal| author=Culpepper L| title=The diagnosis and treatment of bipolar disorder: decision-making in primary care. | journal=Prim Care Companion CNS Disord | year= 2014 | volume= 16 | issue= 3 | pages= | pmid=25317368 | doi=10.4088/PCC.13r01609 | pmc=4195640 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25317368 }}</ref> | ||
* Liver and lipid panel should be evaluated as many anti-psychotics medications cause changes in patients lipid profiles, resulting in dyslipidemia and liver damage. | |||
=== Other laboratory tests === | ===Other laboratory tests=== | ||
* Wilson disease is a rare condition that is easily missed. Urine copper level testing may be performed to rule out Wilson disease, although not a routine screening test in bipolar disorder. | *Wilson disease is a rare condition that is easily missed. Urine copper level testing may be performed to rule out Wilson disease, although not a routine screening test in bipolar disorder.<ref name="pmid18402634">{{cite journal| author=Machado AC, Deguti MM, Caixeta L, Spitz M, Lucato LT, Barbosa ER| title=Mania as the first manifestation of Wilson's disease. | journal=Bipolar Disord | year= 2008 | volume= 10 | issue= 3 | pages= 447-50 | pmid=18402634 | doi=10.1111/j.1399-5618.2007.00531.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18402634 }}</ref><ref name="pmid18789784">{{cite journal| author=Benhamla T, Tirouche YD, Abaoub-Germain A, Theodore F| title=[The onset of psychiatric disorders and Wilson's disease]. | journal=Encephale | year= 2007 | volume= 33 | issue= 6 | pages= 924-32 | pmid=18789784 | doi=10.1016/j.encep.2006.08.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18789784 }}</ref> | ||
*Testing for human immunodeficiency virus (HIV) is important because AIDS causes changes in mental status, including dementia and depression.<ref name="urlHIV and psychiatric comorbidities: What do we know and what can we do?">{{cite web |url=https://www.apa.org/pi/aids/resources/exchange/2013/01/comorbidities |title=HIV and psychiatric comorbidities: What do we know and what can we do? |format= |work= |accessdate=}}</ref> | |||
* Testing for human immunodeficiency virus (HIV) is important because AIDS causes changes in mental status, including dementia and depression. | *Syphilis in its later stage alters mental status, so screening may be indicated in selected patients. | ||
* Syphilis in its later stage alters mental status, so screening may be indicated in selected patients. | |||
=== Substance and Alcohol Screening === | ===Substance and Alcohol Screening=== | ||
* Alcohol abuse and illicit drugs can present as mania or depression. For example, amphetamines and cocaine can present as a mania like disorder, and barbiturate can present as a depression like disorder. | *Alcohol abuse and illicit drugs can present as mania or depression. For example, amphetamines and cocaine can present as a mania like disorder, and barbiturate can present as a depression like disorder.<ref name="pmid23332720">{{cite journal| author=Kenneson A, Funderburk JS, Maisto SA| title=Risk factors for secondary substance use disorders in people with childhood and adolescent-onset bipolar disorder: opportunities for prevention. | journal=Compr Psychiatry | year= 2013 | volume= 54 | issue= 5 | pages= 439-46 | pmid=23332720 | doi=10.1016/j.comppsych.2012.12.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23332720 }}</ref> | ||
* Many patients with bipolar disorder, also have high rate of substance use disorders as a result it is associated with significant morbidity and mortality. | *Many patients with bipolar disorder, also have high rate of substance use disorders as a result it is associated with significant morbidity and mortality.<ref name="pmid23332720" /> | ||
==References== | ==References== | ||
Revision as of 12:05, 26 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]
Overview
No laboratory test is required to establish the diagnosis of bipolar disorder. However, laboratory tests can help to exclude alternative etiologies for mood symptoms. Laboratory tests may include a urine toxicology screen and a complete blood count. Fasting glucose and lipid assessments are important for establishing the presence of diabetes or hyperlipidemia.
Bipolar disorder laboratory findings
- There are no diagnostic laboratory findings associated with Bipolar disorder. However, bipolar disorder enclose both depression and mania and it could be due to many reversible causes, an extensive range of tests is indicated[1]
- Many number of medications that used to treat bipolar disorder have many side effect, for instance lithium requires an intact genitourinary system and can affect certain other systems.[2]
- A complete blood count (CBC) with differential is to rule out anemia as a cause of depression in bipolar disorder.[3]
- Erythrocyte sedimentation rate to look for any underlying disease process such a lupus or an infection.
- Fasting blood glucose level is indicated to rule out diabetes, as well as atypical antipsychotics are associated with weight gain and trouble with blood glucose regulation in patients with diabetes.[4]
- Patients that will be on lithium therapy checking electrolytes is indicated, because low sodium levels may lead to higher lithium levels and lithium toxicity.
- Check the serum calcium as any changes in serum calcium is associated with mental status changes (eg, hyperparathyroidism). An elevated calcium blood level can cause depression or mania.[5]
- In patients with depression as a result of not eating, low serum protein levels increase the availability of certain medications, because these drugs have less protein to which to bind.
- Thyroid function tests to rule out hyperthyroidism (mania) and hypothyroidism (depression). lithium can cause hypothyroidism, for that thyroid tests should be obtained.[6]
- In a study to assess the relationship between bipolar disorder and thyroid dysfunction, they found out that patients with bipolar disorder are two times more commonly associated with thyroid dysfunction than individuals without bipolar disorder.[7]
- Creatinine and blood urea nitrogen should be checked because kidney failure can present as depression, treatment with lithium can affect urinary clearances.
- Liver and lipid panel should be evaluated as many anti-psychotics medications cause changes in patients lipid profiles, resulting in dyslipidemia and liver damage.[8]
Other laboratory tests
- Wilson disease is a rare condition that is easily missed. Urine copper level testing may be performed to rule out Wilson disease, although not a routine screening test in bipolar disorder.[9][10]
- Testing for human immunodeficiency virus (HIV) is important because AIDS causes changes in mental status, including dementia and depression.[11]
- Syphilis in its later stage alters mental status, so screening may be indicated in selected patients.
Substance and Alcohol Screening
- Alcohol abuse and illicit drugs can present as mania or depression. For example, amphetamines and cocaine can present as a mania like disorder, and barbiturate can present as a depression like disorder.[12]
- Many patients with bipolar disorder, also have high rate of substance use disorders as a result it is associated with significant morbidity and mortality.[12]
References
- ↑ Price AL, Marzani-Nissen GR (2012). "Bipolar disorders: a review". Am Fam Physician. 85 (5): 483–93. PMID 22534227.
- ↑ Price AL, Marzani-Nissen GR (2012). "Bipolar disorders: a review". Am Fam Physician. 85 (5): 483–93. PMID 22534227.
- ↑ Culpepper L (2014). "The diagnosis and treatment of bipolar disorder: decision-making in primary care". Prim Care Companion CNS Disord. 16 (3). doi:10.4088/PCC.13r01609. PMC 4195640. PMID 25317368.
- ↑ Culpepper L (2014). "The diagnosis and treatment of bipolar disorder: decision-making in primary care". Prim Care Companion CNS Disord. 16 (3). doi:10.4088/PCC.13r01609. PMC 4195640. PMID 25317368.
- ↑ Culpepper L (2014). "The diagnosis and treatment of bipolar disorder: decision-making in primary care". Prim Care Companion CNS Disord. 16 (3). doi:10.4088/PCC.13r01609. PMC 4195640. PMID 25317368.
- ↑ Krishna VN, Thunga R, Unnikrishnan B, Kanchan T, Bukelo MJ, Mehta RK; et al. (2013). "Association between bipolar affective disorder and thyroid dysfunction". Asian J Psychiatr. 6 (1): 42–5. doi:10.1016/j.ajp.2012.08.003. PMID 23380316.
- ↑ Krishna VN, Thunga R, Unnikrishnan B, Kanchan T, Bukelo MJ, Mehta RK; et al. (2013). "Association between bipolar affective disorder and thyroid dysfunction". Asian J Psychiatr. 6 (1): 42–5. doi:10.1016/j.ajp.2012.08.003. PMID 23380316.
- ↑ Culpepper L (2014). "The diagnosis and treatment of bipolar disorder: decision-making in primary care". Prim Care Companion CNS Disord. 16 (3). doi:10.4088/PCC.13r01609. PMC 4195640. PMID 25317368.
- ↑ Machado AC, Deguti MM, Caixeta L, Spitz M, Lucato LT, Barbosa ER (2008). "Mania as the first manifestation of Wilson's disease". Bipolar Disord. 10 (3): 447–50. doi:10.1111/j.1399-5618.2007.00531.x. PMID 18402634.
- ↑ Benhamla T, Tirouche YD, Abaoub-Germain A, Theodore F (2007). "[The onset of psychiatric disorders and Wilson's disease]". Encephale. 33 (6): 924–32. doi:10.1016/j.encep.2006.08.009. PMID 18789784.
- ↑ "HIV and psychiatric comorbidities: What do we know and what can we do?".
- ↑ 12.0 12.1 Kenneson A, Funderburk JS, Maisto SA (2013). "Risk factors for secondary substance use disorders in people with childhood and adolescent-onset bipolar disorder: opportunities for prevention". Compr Psychiatry. 54 (5): 439–46. doi:10.1016/j.comppsych.2012.12.008. PMID 23332720.