Section 4.8

Background

It can be difficult to engage some patients in the process of assessing the nature and extent of their illnesses; therefore, medical screening may be recommended for inpatients and outpatients with psychotic or major affective mental disorders. Medical Screening may be able to detect sub-clinical side effects, medical conditions that affect mental status, and medical conditions that are unrelated to mental status but require referral.

Specific Psychiatric Indications

In an Orange County mental health inpatient setting, the appropriate medical screening is relatively easier to obtain than in the outpatient setting. When a patient is referred to outpatient mental health after an inpatient evaluation, the complete psychiatric and medical evaluation should be sent to the clinic. The physical exam will have weight, vital signs and any physical findings noted; laboratory results will be listed on a separate page. Abnormal values will have an explanation and arrangements for appropriate follow up, in addition to the mental health outpatient follow up.

When a patient is referred to outpatient mental health without an inpatient evaluation, and there has been no other history, physical or laboratory evaluation in the last year, a medical screening (similar to the inpatient process) should occur for patients with psychotic or major affective mental disorders. The medical screening may detect 1) sub-clinical side effects, 2) medical conditions that affect mental status, and 3) medical conditions that are unrelated to mental status. If abnormal results are detected, then the clinician would manage side effects based on findings. If there are medical findings unrelated to the mental illness, the patient can be informed of a linkage to CalOPTIMA health plans, or other MSI resources can be made.

The outpatient medical screening may be done by the patient?s physical health care doctor or at an outpatient clinic. The clinic medical screening may consist of a history, physical (necessarily limited by resources to include only weight and vital signs), MSE, CBC, Chem 25, thyroid function, RPR, UDS (if mentation is impaired), and pregnancy test (if pregnancy is possible this factor would influence treatment choices).

References

Rosse, R. Giese, A., et al, (1989) Laboratory Diagnostic Testing in Psychiatry, Washington, D.C. American Psychiatric Press.

APA Practice Guidelines for Bipolar Disorder December 1994.

APA Practice Guidelines for Schizophrenia April 1997.

The Journal of Clinical Psychiatry?s Consensus Guidelines for treatment of Bipolar and Schizophrenia from 1996.