The clinical utility and cost effectiveness of routine thyroid screening in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa

Lachman, Anusha; Cloete, Karen J.; Kidd, Martin; Schoeman, Renata

doi:10.4314/ajpsy.v15i1.5

Cited by 4 publications

(14 citation statements)

References 36 publications

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“…8 Finally, in a recent 5-year retrospective review on 1080 patients in South Africa, 1176 TFTs performed on admission were analysed. 7 Of the 162 (5.7%) cases that were abnormal, 22% normalised at follow-up, 67% did not have any follow-up or change to management and 11.7% remained abnormal. 7 The authors concluded no association between abnormal test results and coexisting medical conditions, documented stressors or medications used.…”

Section: Discussionmentioning

confidence: 93%

“…[3][4][5] Abnormal TFTs resulting from these stress-related factors typically normalise within 3-4 weeks without intervention. [5][6][7] Second, TFTs can be affected by the underlying aetiological processes of psychiatric disorders themselves (e.g. inflammatory responses), use of certain illicit substances (e.g.…”

mentioning

confidence: 99%

“…TFTs) for patients being admitted to psychiatric hospitals, often concluding limited utility for this practice. [7][8][9][10][11][12][13] In these studies, routine TFTs appeared to provide limited clinical benefit and imposed unnecessary costs. To our knowledge, however, no evaluation of the role of routine TFTs as part of psychiatric admissions has been undertaken in the Australian context.…”

mentioning

confidence: 99%

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Thyroid function testing in an inpatient mental health unit

Garnier

Ismail

Moylan

et al. 2016

Australas Psychiatry

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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

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confidence: 99%

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Thyroid function testing in an inpatient mental health unit

Garnier

Ismail

Moylan

et al. 2016

Australas Psychiatry

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“…Among psychiatric patients, reversible and irrelevant abnormalities in thyroid function tests are frequent and often due to other factors such as acute psychiatric state, starvation or substance use, rather than to a thyroid problem per se [ 14 ]. Lachman and Garnier do not recommend TSH testing upon admission to psychiatric hospital due to low clinical utility and high costs [ 16 ]. In our analysis, TSH had the second highest DCSAR of all tests (33 €) and eight patients had to be screened to get an abnormal result.…”

Section: Discussionmentioning

confidence: 99%

“…More recent research, conducted especially in the field of the emergency medicine, has mainly focused on the utility of medical clearance, i.e., use of laboratory testing in the differential diagnostics between physical and mental illnesses, once a patient with psychiatric symptoms is treated in the emergency department [ 13 ]. In addition, a few studies have examined thyroid function testing among psychiatric patients [ 14 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

Physical health examination in outpatients with schizophrenia: the cost effectiveness of laboratory screening tests

Eskelinen

Suvisaari

2020

Ann Gen Psychiatry

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Background Guidelines on laboratory screening in schizophrenia recommend annual monitoring of fasting lipids and glucose. The utility and the cost effectiveness of more extensive laboratory screening have not been studied. Methods The Living Conditions and the Physical Health of Outpatients with Schizophrenia Study provided a comprehensive health examination, including a laboratory test panel for 275 participants. We calculated the prevalence of the results outside the reference range for each laboratory test, and estimated the cost effectiveness to find an aberrant test result using the number needed to screen to find one abnormal result (NNSAR) and the direct cost spent to find one abnormal result (DCSAR, NNSAR x direct cost per test) formulas. In addition, we studied whether patients who were obese or used clozapine had more often abnormal results. Results A half of the sample had 25-hydroxyvitamin D below, and almost one-fourth cholesterol, triglycerides or glucose above the reference range. One-fifth had sodium below and gamma glutamyltransferase above the reference range. NNSAR was highest for potassium (137) and lowest for 25-hydroxyvitamin D (2). DCSAR was below 5€ for glucose, all lipids and sodium, and below 10€ for creatinine and gamma glutamyltransferase. Potassium (130€), pH-adjusted ionized calcium (33 €) and thyroid stimulating hormone (33€) had highest DCSARs. Several abnormal results were more common in obese and clozapine using patients. Conclusions An annual laboratory screening panel for an outpatient with schizophrenia should include fasting glucose, lipids, sodium, creatinine, a liver function test and complete blood count, and preferably 25-hydroxyvitamin D.

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Physical Health Examination in Outpatients With Schizophrenia: The Cost-Effectiveness of Laboratory Screening Tests

Eskelinen

Suvisaari

2019

Preprint

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Background: Guidelines on laboratory screening in schizophrenia recommend annual monitoring of fasting lipids and glucose. The utility and the cost effectiveness of more extensive laboratory screening have not been studied. Methods:The Living Conditions and the Physical Health of Outpatients with Schizophrenia Study provided a comprehensive health examination, including a laboratory test panel for 275 participants. We calculated the prevalence of the results outside the reference range for each laboratory test, and estimated the cost effectiveness to find an aberrant test result using the number needed to screen to find one abnormal result (NNSAR) and the direct cost spent to find one abnormal result (DCSAR, NNSAR x direct cost per test) formulas. In addition, we studied whether patients who were obese or used clozapine had more often abnormal results.Results: A half of the sample had 25-hydroxyvitamin D below, and almost one-fourth cholesterol, triglycerides or glucose above the reference range. One-fifth had sodium below and gamma glutamyltransferase above the reference range. NNSAR was highest for potassium (137) and lowest for 25-hydroxyvitamin D (2). DCSAR was below 5€ for glucose, all lipids and sodium, and below 10€ for creatinine and gamma glutamyltransferase. Potassium (130€), pHadjusted ionized calcium (33 €) and thyroid stimulating hormone (33€) had highest DCSARs. Several abnormal results were more common in obese and clozapine using patients.Conclusions: An annual laboratory screening panel for an outpatient with schizophrenia should include fasting glucose, lipids, sodium, creatinine, a liver function test and complete blood count, and preferably 25-hydroxyvitamin D.

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The clinical utility and cost effectiveness of routine thyroid screening in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa

Cited by 4 publications

References 36 publications

Thyroid function testing in an inpatient mental health unit

Thyroid function testing in an inpatient mental health unit

Physical health examination in outpatients with schizophrenia: the cost effectiveness of laboratory screening tests

Physical Health Examination in Outpatients With Schizophrenia: The Cost-Effectiveness of Laboratory Screening Tests

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