Butler Matthew, Scott Fraser, Stanton Biba, Rogers Jonathan
King's College London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
BJPsych Bull. 2021 Dec 3;46(3):1-4. doi: 10.1192/bjb.2021.125.
Psychiatrists often order investigations such as blood tests, neuroimaging and electroencephalograms for their patients. Rationales include ruling out 'organic' causes of psychiatric presentations, providing baseline parameters before starting psychotropic medications, and screening for general cardiometabolic health. Hospital protocols often recommend an extensive panel of blood tests on admission to a psychiatric ward. In this Against the Stream article, we argue that many of these investigations are at best useless and at worst harmful: the yield of positive findings that change clinical management is extremely low; special investigations are a poor substitute for a targeted history and examination; and incidental findings may cause anxiety and further unwarranted investigation. Cognitive and cultural reasons why over-investigation continues are discussed. We conclude by encouraging a more targeted approach guided by a thorough bedside clinical assessment.
精神科医生经常为他们的患者安排诸如血液检查、神经影像学检查和脑电图检查等项目。理由包括排除精神症状的“器质性”病因、在开始使用精神药物之前提供基线参数以及筛查一般心脏代谢健康状况。医院的诊疗规范通常建议在患者入院到精神科病房时进行一系列广泛的血液检查。在这篇逆流而上的文章中，我们认为这些检查中的许多充其量是无用的，最坏的情况是有害的：改变临床管理的阳性检查结果的检出率极低；特殊检查并不能很好地替代有针对性的病史采集和体格检查；偶然发现可能会引起焦虑并导致进一步不必要的检查。文中讨论了过度检查持续存在的认知和文化原因。我们通过鼓励采用以全面的床边临床评估为指导的更具针对性的方法来得出结论。
