Introduction and Alignment
Laboratory tests should be ordered or reviewed for every mental health patient. Many of the patients that come to you will have seen their primary care doctors within the past year. It is acceptable for you to have the patient sign a release of information (ROI) so that you can request their previous labs for a baseline and to include them on the chart in our office. There may be times that you feel that the labs need to be repeated due to previous abnormal values, amount of time since testing or presenting symptoms. Labs are commonly ordered and depending on the patient’s insurance carrier can be expensive. If labs are not drawn in your office, they may also be inconvenient for the patient. And often times, patients will complain about the discomfort associated with the initial stick for venous access. It is important for the PMHNP to know the most common labs that are indicated for review and chart inclusion for mental health patients according to diagnosis and medications being prescribed. All mental health patients should have a CBC, CMP, Lipid panel, TSH, Vitamin D and Vitamin B12 at a minimum. For certain disorders and medications (anticonvulsants and atypical antipsychotics) you may need to consider additional lab tests. What additional labs do you need to consider? You should include these additional labs in your PowerPoint™. Depending upon presentation, history and office practice, you may also need to order UDS on each patient initially and at established intervals. Include specifics that you are looking for with the UDS. How often should labs be ordered?
Genetic testing is now being used to identify what medications may be more acceptable or contraindicated for patients based upon their genetic map. There are multiple tests and labs that have been developed and marketed to providers to potentially aid in medication management choices. There are some limitations with the testing. The most important being that they predict metabolism and bioavailability of medications but they do not predict a patient’s clinical response (improvement in mental health) to a particular medication. Genetic testing is most commonly performed using buccal swabs. The provider will swab the patient’s oral cavity and then send the specimen to the lab for processing via UPS or FedEx.
Background Information
In this workshop, you will discuss each test listed above and laboratory values that may indicate that the patient is suffering from a metabolic issue versus a mental health issue. Some metabolic imbalances can mimic or produce mental health symptoms.
In this workshop, you will examine the tests mentioned and their pertinence in mental health care assessment and management.
The best PowerPoint presentations use standardized positions and style. They provide only necessary information and when combined with graphics are entertaining as well as informative. The PowerPoint will have colors that contrast and complement each other. Also, do not try to include all of the information on the PowerPoint slide itself. Information can be entered into the notes section to be used during the presentation. You want your audience to have fun and be engaged.
Instructions
- Develop a PowerPoint™ presentation to discuss each of the above highlighted labs and how pertinent findings may impact your mental health diagnosis and treatment plan. Briefly explain the disorder you are ruling out or in with the testing results and state the rationale for the testing needed in the scenario. Be as specific as possible providing a basic overview of the tests that you are assessing as well as the benefits, risks, and limitations. Use on slide for each bolded test – use the notes section on PPT to relay added information regarding each test.
- Provide citations for information on each slide.
- When you have completed your assignment, save a copy for yourself and submit a copy to your instructor using the 3.2 Assignment by day Five of the workshop.
- Submit a copy in the Laboratory testing discussion thread for your peers to read on day Six.
- Review the rubric to make sure you understand the criteria for earning your grade.