After 3 months, she’s still ‘mad’

Check complete blood count, electrolytes, thyroid panel, urinalysis, urine drug screen, blood urea nitrogen, and creatinine to rule out an underlying metabolic or endocrinologic cause for psychosis. Watch for signs of anticholinergic syndrome during physical examination.

If any of the above results suggest a medical problem, test for the following as clinical suspicion warrants:

• serum copper/ceruloplasmin and liver function to rule out Wilson’s disease, a genetic disorder that causes copper to accumulate in the liver and brain
  
• systemic lupus erythematosus
  
• lead, magnesium, mercury, or manganese to rule out metal poisoning.
  

Order additional blood testing to check for vitamin B₁₂ deficiency, brain MRI to rule out Alzheimer’s or subcortical dementia, EEG to check for an infectious or malignant disorder or for cerebral dysfunction, or ECG to rule out a metabolic or degenerative disorder or electrolyte imbalance.

Related resources

• Cronin AJ. The Citadel. Boston: Little, Brown & Co.;1937:399.
  
• Asher R. Myxoedamatous madness. BMJ 1949;2:555-62.
  

Drug brand names

• Aripiprazole • Abilify
  
• Captopril • Capoten
  
• Clozapine • Clozaril
  
• Haloperidol • Haldol
  
• Levothyroxine • Synthroid
  
• Olanzapine • Zyprexa
  
• Risperidone • Risperdal
  

Disclosures

The author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.