Recommended baseline investigations for BD
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
The recommended investigations should assist clinicians in management and are not diagnostic in nature. The list below represents a list of possibilities to be considered where clinically appropriate and does not represent an exhaustive list of tests to be performed in every patient with suspected BD.
Baseline investigations:
- Extrapyramidal side-effects: clinical assessment of abnormal involuntary movements
- Cataracts: ocular examination (quetiapineonly)
- Metabolic syndrome:
- Waist circumference
- Body mass index
- Blood pressure
- Fasting lipid profile (triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL))
- Fasting blood sugar
- Screen/test:
- Full blood count
- Blood chemistry:
(i) Electrolytes
(ii) Serum creatinine
(iii) Thyroid-stimulating hormone
(iv) Liver function tests - Prolactin levels (if indicated)
- Substance use: urine toxicology (if indicated)
- Polycystic ovarian syndrome: reproductive endocrine abnormalities (if prescribing valproate to females of child-bearing potential)
- Pregnancy test (if indicated, especially if prescribing valproate, or carbamazepine)• Test for infectious diseases (if indicated)
- Perform:
- Electrocardiogram (ECG) (if prescribing lithium and age >40 years)
- Electro-encephalograph (EEG) (if indicated)
- Magnetic resonance imaging (MRI) (preferred)/computed tomography (CT) – indicated in suspected organic aetiology.