1. LABORATORY TESTS IN PSYCHIATRY
Dr Anna Szota

2. Psychiatry depends more on the clinical examination and the patient’s signs and symptoms to make an diagnosis than do other medical specialists. No laboratory tests in psychiatry can confirm or rule out diagnosis such as schizophrenia, bipolar I disorder, and major depressive disorder. However, laboratory tests have become increasingly valuable for clinical psychiatrists.
In clinical psychiatry, laboratory tests can help rule out potential underlying organic causes of psychiatric symptoms - for example impaired copper metabolism in Wilson’s disease and a positive result on antinuclear antibody (ANA) in systematic lupus erythematosus (SLE).

3. Laboratory work then is used to monitor treatment, such as measuring the blood levels of antidepressants medication and assessing the effects of lithium on electrolytes, thyroid metabolism and renal function. However laboratory data can serve only as an underlying support for the essential skill of clinical assessment.
BASIC SCREENING TESTS
These tests are made in order to:
rule out organisity
screen for concurrent diseases
establish baseline values of functions to be monitored

4. Some medical conditions that may manifest
with neuropsychiatric symptoms
Neurological
Cerebrovascular disorders (hemorrhage)
Epilepsy
Parkinson's disease
Huntington's disease
Migraine
Dementia of Alzheimer's type
Endocrine
Hypothyroidism, hyperthyroidism
Hypoglycemia, hyperglycemia
Diabetes mellitius
Toxic
Intoxication or withdrawal associated with drug or alcohol abuse
Environamental toxins (heavy metals, carbamonoxide)

5. Metabolic and systemic
Hepatic encephalopathy
Uremia
Porphyria
Hepatolenticular degeneration (Wilson's disease)
Nutrional
Vitamine B12 deficiency (anemia)
Folate deficiency (megaloblastic anemia)
Trace metal deficiency (zinc, magnesium)
Infectious
Neurosyphilis
Viral hepatitis
Systemic bacterial infections
Acquired immunodeficiency syndrome (AIDS)
Neoplastic
Central nervous system (CNS) primary tumors
Endocrine tumors
Autoimmune
Systemic lupus erythematosus (SLE)

6. Evaluation of the patients’ health includes:
medical history
routine medical laboratory tests
a complete blood count – CBC
hematocrit
hemoglobin
renal function tests
liver function tests
thyroid function tests
determination of chloride, sodium, potassium, bicarbonate, serum urea nitrogen, creatinine, and blood sugar levels
urine test
urine toxicology or serum toxicology tests when drug use is suspected by the interviewer.

7. 1. BIOCHEMISTRY PANEL
FASTING BLOOD SUGAR
done for evaluation of diabetes or other abnormalities in glucose level
patients who take atypical antipsychotic agents should be monitored for development of hyperglycemia and glycosylated hemoglobin level (diabetes mellitus)
extremes in serum glucose concentrations are in delirium tremens
hypoglycemia appears in anxiety, agitation, panic attacks, depression and delirium

8. LIPIDS
increase in TG, LDL cholesterol, total cholesterol and decrease in: HDL cholesterol is observed in weight gaining
increase in TG, decrease in: HDL cholesterol and LDL cholesterol is observed in alcohol abuse
increase in ratio of total cholesterol/cholesterol HDL is observed in metabolic syndrome in patients cured with olanzapine (schizophrenia)
increase in TG, VLDL cholesterol, LDL cholesterol and decrease in HDL cholesterol in patients with kidney’s failure and diabetes mellitus

9. 2. ELECTROLYTES
Sodium (Na+)
disturbance distribution of sodium in depression and bipolar disorder
changes in levels of sodium during treatment with carbamazepine and lithium (higher sensitivity for lithium when sodium level is decreased)
sodium is measured in diagnosis of cognitive disorders
Potassium (K+)
decreased level in: anorexia nervosa and bulimia
disturbance distribution of potassium in depression and bipolar disorder
hyperkalemia in anxiety disorders
decreased level in hepatic cirrhosis e.g. in alcoholism

10. Chlorides (Cl-)
hypochloremia in bulimia
hyperchloremia in panic disorders
OTHER IONS
Calcium (Ca2+)
increase associated with delirium, depression, psychosis and schizophrenia
decreased level in: hypothyroidism, kidney failure, depression and delirium
Magnessium (Mg2+)
decreased in alcohol dependence
low levels associated with agitation, delirium and seizures

11. 3. HEMATOLOGY
Red blood count (RBC)
Hemoglobin (HGB)
Hematocrit (HCT)
- decreased levels are observed in: iron deficiency anemia, aplastic anemia, lack of B12 vitamin and folate (alcoholism)
- increased levels in: intra blood corpuscule disturbances (eliptocytosis, sferocytosis)
Hemoglobin (HGB) and Hematocrit (HCT)
- decreased in anemias

12. Mean corpuscular volume (MCV)
microcytic anemia, decreased volume of cell (MCV< 83 µm3 )
- iron deficiency anemia
syderoblastic anemia
normocytic anemia (MCV normal)
- aplastic anemia
endocrynologic disturbance
macrocytic anemia, increased volume of cell (MCV > 103 µm3 )
- megaloblastic anemia (lack of b12 vitamin or folate ,like in alcoholism)
- non-megaloblastic anemia (liver diseases, hypothyroidism, leukemia)
anemia caused by the drugs
Mean corpuscular hemoglobin (MCH)
- decreased value in anemia associated with decreased synthesis of HGB

13. Mean corpuscular hemoglobin concentration (MCHC)
decreased value of MCHC is observed when synthesis of HGB is decreasing faster than mean corpuscular volume (MCV)
Platelets = thrombocytes (PLT)
- play role in blood clotting
in alcoholic patients with liver damage time of bleeding is increased
White blood corpuscules (WBC)
- increased in inflammatory states
- use to exclude leukemia
- eosinophilia caused by curing with carbamazepine
- monocytosis in patients having syphilis
- basophilia in patients with: diabetes mellitus, hypothyroidism, anemia (iron deficience) and after taking some drugs
- limphopenia in patients infected with: HIV virus, VZV virus; aplastic anemia
- limphocytosis: in aplastic anemia and infections: syphilis

14. Thyroid disease and other endocrinopathies can present as a mood disorder or psychotic disorder;
cancer or infection disease can present as depression; infection and connective tissue diseases can present as a short-time changes in mental status.
Additionally, a lot of patients suffering from organic diseases come at first to psychiatrist.
Among these diseases are: multiple sclerosis, Parkinson’s disease, dementia of the Alzheimer’s type, Huntington’s disease, dementia caused by human immunodeficiency virus (HIV) and temporal lobe epilepsy.

15. 4. NEUROENDOCRINE TESTS
THYROID FUNCTION TEST
Thyroid measures:
thyroxine (T4) by competitive protein binding (T4D) or radioimmunoassay (T4RIA) involving antigen-antibody reaction
More than 90% of T4 is bound serum protein and is responsible for thyroid-stimulating hormone (TSH) secretion and cellular metabolism
free (T4)
triiodothyronine uptake
total serum triiodothyronine by radioimmunoassay (T3RIA)
These tests let to rule out hypothyroidism, which appears with symptoms of depression.

16. Symptoms common to both: depression and hypothyroidism include:
weakness
stiffness
poor appetite
constipation
menstrual irregularities
slow speech
apathy
impaired memory
even hallucinations and delusions
Hypothyroidism can be caused by lithium (necessity of thyroid function monitoring).

17. THYROTROPIN-RELEASING HORMONE (TSH) stimulation test
indicated for patients with suspicion of subclinical hypothyroidism, which account for clinical depression
the procedure: intravenous (iv) injection of 500 mg of TRH →sharp rise in serum TSH measured at 30, 60, 90 minutes
increase of TSH from 5 to 25 international units per milliliter (IU/ml) above baseline is normal
- increase less than 7 IU/ml → blunted response → correlate with depressive disorder

18. DEXAMETHASONE-SUPPRESION TEST
the dexamethasone-suppresion test (DST) is used to confirm major deppresive disorder with melancholia symptoms or endogenic depression
the procedure: patient takes 1 mg of dexamethasone (a long-acting synthetic glucocorticoid) by mouth by 11 pm
plasma cortisol concentration above 5 mg/ml (known as nonsuppression) are abnormal → positive result of the test
suppression of cortisol indicates that the hypothalamic-adrenal-pituitary axis is functioning properly
- patients with positive DTS result (especially,10 mg/ml) will have a good response to somatic treatment, such as electroconvulsive therapy(ECT) or cyclic antidepresant therapy

19. OTHER ENDOCRINE TESTS
Many other (than thyroid ) hormones affect behavior. Among them we have:
prolactine
growth hormone
somatostatin
gonadotrophin releasing hormone
the sex steroids
melatonin (connected with seasonal affective disease).
On the basis of unspecified changes in endocrine function some symptoms of anxiety or depression may by explained.

20. 5. CATECHOLAMINES AND INDOLOAMINES
5-hydroxyindoleacetic acid (5-HIIA)- metabolite of serotonine
elevated level of this metabolite in urine is detected in patients with: carcinoid tumors, in patients who take phenothiazine medication and in those who eat food high in serotonin
- concentration of 5-HIIA in cerebrospinal fluid is low in patients with suicidal depression and (post mortem) in those who have committed a suicide in particularly violent way

21. norepinephrine (NE) and epinephrine (E)
elevated blood levels of these catecholamines are in anxiety disorders and pheochromocytoma associated with anxiety and agitation
high levels of urinary NE and E are in patients with posttraumatic stress disorder
low urinary norepinephrine - to epinephrine ratio (NE:E) is in patients with depression
- low concentration of norepinephrine metabolite 3-methoxy-4hydroxyphenyl-glycol (MHPG) is in patients with severe depressive disorders, especially in patients who attempt suicide.

22. 6. KIDNEY FUNCTION TESTS
Method of estimation of kidney functions:
- serum level of creatinine
- level of blood urine nitrogen (BUN)
- creatinine clearance (24-hour urine) urinalysis
- FGR (gromerular filtration rate)
- inuline clearance
- urinalysis
Important: serum BUN and creatine levels must be monitored in patients taking lithium - high risk of damage of kidneys.

23. BUN, creatinine (elevated)
CONDITIONS
TESTS USED IN DIAGNOSIS
TESTS USED TO FOLLOW
Acute renal failure
Chronic renal failure
BUN, creatinine (elevated)
BUN, creatinine (elevated) estimated GFR (decreased), urinalysis (red blood cells, white blood cells, albumin)
BUN, creatinine
BUN, creatinine, estimated GRF,eletrolytes, calcium, phosphatase,alkaline phosphatase, parathyroid hormone, cystatine C
Urinary tract infections
Urinalysis, urine culture
Urynalysis, urine culture
Kidney stones
Urynalysis
Urine sodium, calcium, phosphorus,citrate, oxalate, uric acid
Nephrotic syndrome
Urinalysis, serum albumin, total protein, cholesterol,  urine total protein, antinuclear antibody (ANA) test,  hepatitis B test, Hepatitis C test 
Urine total protein, serum cholesterol, BUN, creatinine, estimated GFR
Kidney disease due to diabetes or high blood pressure
Albumin (elevated)
Albumine, urine total protein,BUN, creatinine, estimated GFR

24. 7. LIVER FUNCTIONS TESTS
- total bilirubin
- direct bilirubin
indirect bilirubin
Hyperbilirubinemia
- elevated levels of total bilirubin and direct bilirubin (hepatocellural injury and intrahepatie bile stasis)
caused by: phenothiazine or tricyclic medication, alcohol and other abuse substances
Hypobilirubinemia
decreased serum bilirubin caused by some drugs e.g. Phenobarbital (Luminal)
Measurement of bilirubin level is necessary due to diagnosis of cognitive disorders.

25. Enzymes
- alanine aminotransferase (ALT)
- aspartate aminotransferase (AST)
- lactate dehydrogenase (LDH)
- alkaline phosphatase (ALP)
- cholinesterase (ChE)
- gamma-glutamyl transferase (GGTP)
Alanine aminotransferase (ALT)
- in liver, kidneys and muscles
- very high levels in: acute hepatitis, chronic hepatitis caused by HBV and HCV viruses or toxic influence of drugs
- increased levels in: drug-induced damage of liver, cholestasis, cirrhosis of the liver, liver tumor

26. Aspartate aminotransferase (AST)
- in liver, kidneys, muscles and red blood corpuscules
- very high levels in: toxic damage of liver, acute hepatitis, chronic hepatitis
- increased levels in: alcohol-induced damage of liver, cirrhosis of the liver, liver tumor, heart attack, muscules damage
‘de Ritis’ indicatior – activity AST/ALT
AST/ALT= 2 (hepatitis caused by alcohol)
AST/ALT ≥ 100 (acute hepatitis caused by virus, toxic influence of drugs)
Lactate Dehydrogenase (LDH)
- in liver, brain, red blood corpuscules, kidneys, lungs and muscles
- very high levels: in liver tumor
- high levels: in acute and chronic hepatitis
Alkaline Phosphatase (ALP)
- 3 isoforms:
ALPI – intestinal
ALPL – tissue non-specific (liver/bone/kidney)
ALPP – placental (Regan isozyme)
- high levels in: cholestasis, cirrhosis of the liver, liver tumor, tumor of other organs and diseases of the bones

27. Choline esterase (ChE)
- decrease levels in: liver tumor, malnutrition and traumatic shock
Gamma-glutamyl transferase (GGTP)
- in: bile ducts, kidneys, liver, pancrease
- high levels: in chronic hepatitis, cholestasis, cirrhosis of the liver and alcohol - induced damage of the liver
very high levels: liver tumor
Release of GGTP is induced by:
- barbiturates, estrogens, fenytoine (high increase of GGTP)
- alcohol (heavy alcohol intake, to estimate abstinence in alcoholics during therapy)

28. LIVER FUNCTION TESTS (LFT):
- reflects liver damage or disease
- abnormal findings in liver can manifest with signs and symptoms of cognitive disorder, including disorientation and delirium
impaired hepatic function can increase of half-lives of certain drugs e.g. benzodiazepines, so the drug may stay in patient’s system longer than it would under normal circumstances
LFT must be monitored routinely when using certain drugs such as: carbamazepine (Tegretol) and valproate (Depakine)

29. 8. BLOOD TESTS FOR SEXUALLY TRANSMITTED DISEASES
VENERAL DISEASE RESEARCH LABORATORY (VDRL)
- is a screening test for syphilis
- if positive the result is confirmed by using specific fluorescent treponemal antibody-absorption (FTA-ABS)
central nervous system (CNS VDRL) test is performed in patients with suspected neurosyphilis.
Symptoms: mood disorder, cognition impairment, delusions, hallucinations.
HIV VIRUS
- causes AIDS (acquired immune deficiency syndrome).

30. 9.TEST RELATED TO PSYCHOTROPIC DRUGS
In caring for patients receiving psychotropic medication it is necessary to measure regularly the concentration of the prescribed drugs in plasma.
BENZODIAZEPINES
no special tests are needed for patients taking this drug
impaired hepatic function increases the half-life of benzodiazepines (be careful with the dose of the drug in order to not overdose the drug)
- in patients being treated for substance abuse urine is tested routinely for benzodiazepines level

31. antipsychotics are metabolized in liver and excreted in urine
no special tests are needed for patients taking antipsychotics, but is good to obtain baseline values for liver function and a complete blood cell count
antipsychotics are metabolized in liver and excreted in urine
all antipsychotic (except clozapine) cause short term elevation in prolactin serum concentration. Normal prolactin level indicates either non-compliance or non-absorption
- adverse effects: leukocytosis, leucopenia, impaired platelet function, mild anemia (both aplastic and hemolytic) and agranulocytosis

32. low-potency antipsychotics are more likely cause agranulocytosis, can cause hepatocellular injury and intrahepatic biliary stasis (total and direct bilirubin and transaminases are elevated).
Clozapine
- because of the risk of agranulocytosis CBC is determined each week during first 6 months of treatment, after this time CBC is determined each 2 weeks.

33. MOOD STABILIZERS
Lithium
before and during treatment with lithium it is necessary to do: thyroid function tests, concentration of electrolits, level of leucocytes, renal function tests (BUN, creatinine, specific weight of urine)
lithium can cause: leucocytosis, hypothyroidism, disturbances in urine concentration
level of this drug is estimated in blood taken after 8-12 hours of the last dose of the drug, before taking morning dose.
Measurement should be repeated twice a week, later ones a week, then twice a month and finally ones per month.

34. ANTICONVULSANTS
Carbamazepine
before treatment with carbamazepine it is necessary to measure complete blood count (CBC), platelet (PLT), reticulocyte and iron concentration in blood
in first 3 months researches should be repeated each week, later each month
adverse effects: anemia (both aplastic and hemolytic), agranulocytosis, thrombocytopenia, leucopenia
- liver tests should be done each 3-6 months (low risk of toxic influence on liver)

35. Valproate
therapeutic range of valproic acid and divalproex (Depakote) is between ng/ml
- above 125 ng/ml adverse effects occur:
sudden and severe, possibly fatal, fluminating impairments in liver, hematopoetic and/or pancreatic function, especially in those just starting the medication
blood dyscrasia, jaundice, thromobocytopenia,and prolonged coagulation (clotting) times due to a lack of blood cells
- patients who develop jaundice or who have bilirubin above 3mg/dl must be withdrawn from the drug

36. ANTIDEPRESSIVE DRUGS
TRICYCLIC AND TETRACYCLIC DRUGS
concentration of tricyclic drugs such as: imipramine, amitryptyline should be done routinely in treatment of depressive disorders
when there is an urgent need to know whether the therapeutic or toxic plasma level of the drug has been reached
blood level measurement should also include metabolites of this drug e.g. imipramine – dezipramine; amitryptyline- nortryptyline
Measurement of the level of these drugs in patient’s serum are difficult and practically are made in patients with endogenic depression without delusions.

37. 10. PROVOCATION OF PANIC ATTACKS WITH SODIUM LACTATE
iv injection of sodium lactate causes panic attack in patients with panic disorder
lactate provocation is used to confirm a diagnosis of panic disorder and to trigger flashbacks in patients with post traumatic stress disorder (PTSD)
- panic attacks triggered by sodium lactate are not inhibiting by peripherally acting β-adrenergic receptor antagonists, but are inhibited by alprazolam and tricyclic drugs

38. 11. INTERVIEW WITH AMOBARBITAL (AMYTAL)
have both diagnostic and therapeutic indications
diagnostic: it is helpful in differentiating non-organic and organic conditions, especially in patients with symptoms of catatonia, stupor and muteness
infusions with amobarbital worsen organic conditions and change for better non-organic or psychogenic conditions (disinhibition, decreased anxiety, increased relaxation)
therapeutically: it helps in the recovery of memory in psychogenic amnestie disorders and fugue, in facilitation of emotional expression in posttraumatic stress disorder

39. 12. Urine
Urine analysis
Proteins
Albuminuria: kidney disease
Glucose
Glucosuria: diabetes mellitus
Ketone bodies
Ketonuria: diabetes mellitus
Creatinine
if positive result: kidney disease
Bilirubin, urobilinogen, blood- negative

40. Urinary sediment: Hematuria- kidney disease
red blood corpuscules (1-3) in microscope view –normal
Hematuria- kidney disease
white blood corpuscules (0-5) in microscope view- normal
infection e.g. bacterial – a lot of bacterias
epithelium cells:
Epitelium cells of renal tubule- kidney injury
urinary cast:
Urinary cast in urine are associated with albuminuria- kidney injury
lipids
Lipiduria , associated with albuminuria- kidney injury
bacterias, viruses, Saccharomycetes ect.- inflammatory process
minerals:
Crystals: urolithiasis, nephropathy

41. 13.URINE TOXICOLOGY TESTS
URINE TESTING FOR SUBSTANCE ABUSE
A number of substances may be detected in patient’s urine if the urine is tested in within a specific period after ingestion of the substance.
Substances of abuse that can be detected in urine
Substance Length of time detected in urine Alcohol hours
Amphetamine h
Barbiturate h (short-acting), 3 weeks long-acting
Benzodiazepine days
Cannabis days to 4 weeks (depending on use)
Cocaine h (metabolites 2-4 days)
Codeine h
Heroin h
Methadone days
Methaqualone days
Morphine h
Phencyclidine (PCP) days

42. ALCOHOL
Laboratory testing may be used to help detect chronic and/or relapse alcohol drinking in those who deny it
and to help evaluate organ function.
Tests include:
Gamma glutamyl transferase (GGTP), a liver enzyme that is increased by heavy alcohol intake and by many other conditions that affect the liver
Mean corpuscular volume (MCV), which measures the size of red blood cells; usually measured as part of a Complete Blood Count (CBC) test; the MCV may increase over time in those who are heavy drinkers but may also be affected by many other conditions
Comprehensive Metabolic Panel (CMP) or Liver panel, groups of tests that are used to evaluate organ and liver function (ALAT, ASPAT)
Magnesium, can be low in those who are alcoholic due to insufficient dietary intake

43. Folate test, with alcohol abuse, less B12 and folate are absorbed and more are excreted from the kidneys (decreased level is connected with symptoms: psychosis, agitation, hallucinations and alcoholic dementia)
Carbohydrate-deficient form of transferrin (CDT), a molecule involved in iron transport in blood; CDT is a relatively new test that is sometimes used to help identify chronic heavy drinking.
A toxicology screen or blood alcohol level (ethanol test) are tests that can be used to determine if a person has been drinking alcohol recently, but do not diagnose alcoholism.
Symptoms of intoxication:
- irritability, violent behaviour, feelings of depression, and in rare instances: hallucinations and dellusions
- harmful drinking: liver damage (alcoholic hepatitis, hepatic cirrhosis), pancreatitis, depression and dysphoria.

44. (Morphine, heroin, methadone)
Substance
Symptoms of ingestion
1. OPIOIDS
(Morphine, heroin, methadone)
Opioid-induced: psychotic disorder, mood disorder, anxiety disorder,
2. CANNABIS
(Marihuana)
Feeling "stoned", relaxation , distorted perception, vivid sights, vivid sounds, hunger - commonly called the "munchies", increased laughing, unawareness of time passage
Harmful intoxication: anxiety, fear of dying, panic,panic attack,psychosis,hallucinations,
paranoia, confusion

45. How we may feel………

46. 3.SEDATIVE DRUGS AND
HYPNOTIC DRUGS
(benzodiazepine, barbiturate)
Acute intoxication: disturbance of consciousness or even coma;
Harmful intoxication: mood disorders (depression, dysphoria, anxiety, sleep disturbances),
Barbiturate: anxiety with panic attacks, dellusion of persecution, mood decrease connected with suicide attempts
4. PSYCHOACTIVE ADRUGS (amphetamine, cocaine)
Symptoms of organic psychosis, including hallucinations (visual), delusions (hearing voices), thought disorder, confusion, increased aggression, depressive symptoms and in extreme cases, catatonia, delusive psychosis with persecutory and proximal contents (difficult to differentiate from schizophrenic psychosis)

47. 5. HALLUCINOGENS
(LSD, ecstasy, psylocibin)
distortion of sight, sound, and touch, confusion of the senses—sounds are "seen" or vision is "heard", disorientation in time and space, delusions of physical invulnerability (especially with LSD), paranoia, unreliable judgment and increased risk taking, anxiety attacks, flashbacks after the drug has been cleared from the body, euphoria, impaired concentration and motivation, long-term memory loss, personality changes, especially if there is a latent psychiatric disorder
“bad- trip”- psychosis with anxiety, hallucinations and delusions connected with aggression and suicidal risk
6. GASEOUS SOLVENT
(nitrous oxide, trichloroethylene, acetone)
the effects of inhalants range from an alcohol-like intoxication and intense euphoria to vivid hallucinations; harmful intoxication: damage of the liver, kidneys and brain

48. 14. OTHER TESTS TEST DISEASES Albumin
decreased in malnutrition, hepatic failure, carcinomas
Aldolase
increased in bulimic patients and schizophrenia (60-89%)
Amylase
increased in bulimia nervosa
Antinuclear antibodies
(ANA)
found in systemic lupus erythematosus (SLE) and drug induced lupus, secondary to e.g. anticonvulsants; SLE can be associated with delirium, psychotic disorders and mood disorders
Bicarbonate
decreased in panic disorder
Combs tests direct and indirect
hemolytic anemias secondary to psychotropic medication
Copper, urine
elevated in Wilson’s disease
Cortisol (hydrocortisone)
increased in Cushing’s disease associated with anxiety, depression
Ebstein-Barr (EBV)
Cytomegalovirus (CMG)
EBV is causative agent for mononucleosis, which can manifest with depression and personality change
CMG may produce: anxiety, confusion and mood disorders

49. TEST
DISEASES
Estrogen
decreased in menopausal depression
Gonadotropin-releasing hormone (GnTH)
decreased in schizophrenia,
increased in anorexia nervosa
variable in depression and anxiety
Hepatitis A viral antigen (HAAg)
may present with anorexia nervosa and depression
Hepatitis B surface antigen (HBsAg)
chronic liver disease
Iron
iron-deficiency anemia
Lutenizing hormone (LH)
decreased in depression
Myoglobin (in urine)
increased in neuroleptic malignant syndrome, in PCP, LSD intoxication
Parathormone
decreased level in anxiety
Salicylans
toxic levels in suicidal attempts
Witamin B12
decreased level may cause psychosis, delirium and dementia

50. Thank you